# ERCP-induced perforation: review and revisit after half a century

## TL;DR

This paper reviews ERCP-induced perforations over 50 years, finding that difficult cannulation is a key risk factor and conservative treatment can work in some cases.

## Contribution

The study provides updated insights into the incidence, management, and outcomes of ERCP-induced perforations based on long-term clinical experience.

## Key findings

- ERCP-induced perforation occurred in 13 out of 996 procedures.
- Difficult cannulation was the main predisposing factor (P = 0.003).
- Conservative treatment was effective for type IV perforations.

## Abstract

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is an invasive procedure. We aimed to investigate ERCP-induced perforations at our institution and conduct a comprehensive review of literature on ERCP-induced perforations (EIP) since the introduction of this procedure as a therapeutic intervention.

Methods: This was a case-control study, in which charts of all patients diagnosed with ERCP-induced duodenal perforation were reviewed and compared to a control group without perforation. Patient’s sociodemographic and clinical data, including ERCP procedure-related data, were gathered.

Results: A total of 996 ERCP procedures were performed; only 13 patients proved to have EIP. Obstructive jaundice was the most common indication for ERCP. The main predisposing factor was difficult cannulation (P = 0.003). In total, five patients required surgical treatment; the majority of them had type I perforation, whereas type IV was the most common in patients who were treated conservatively. The overall mortality rate was 15%, the surgical group had a slightly higher mortality rate.

Conclusions: Fifty years after the introduction of ERCP for therapy, it remains an invasive procedure that carries significant morbidity and mortality, even in skilled hands or at high- volume units. Conservative management of perforation yields favorable outcomes in selected patients.