Perforation due to ERCP

Iatrogenic duodenal and pancreaticobiliary perforations associated with endoscopic retrograde cholangiopancreatography (ERCP) are rare but associated with a significant morbidity and mortality. Perforations can be caused by the endoscope itself, secondary to endoscopic sphincterotomy, or related to the use of accessories (guidewires and stents). There is no consensus to direct the clinician on proper management of ERCP-related perforation. Traditionally perforations were classified according to their etiology and anatomical site and managed accordingly. Recently, the time to diagnosis, clinical state of the patient, and results of imaging studies have been shown to better predict the need for surgical intervention. This review summarizes perforations related to ERCP, with an emphasis on the criteria to determine if medical or surgical intervention is the appropriate management strategy.