Abstract
Background and aims Perforation is one of the worst complications of therapeutic endoscopic retrograde
cholangiopancreatography (ERCP). We aimed to study the epidemiology of ERCP related
perforation and the impact of completion of intended procedure on the outcome of this
complication.
Methods ERCP records from January 2007 to April 2012 were independently evaluated by two
investigators for the occurrence of procedure related perforations. A total of 11 500
patients underwent therapeutic ERCP during the study period. The case records of 171
(1.5 %) patients with ERCP related perforations were reviewed to analyze the epidemiology
and risk factors associated with poor outcome.
Results Of the 171 patients included in this study, the majority of perforations (n = 129,
75.4 %) were related to use of the needle-knife precut technique. Female gender (1.9 %
vs 0.7 %, P < 0.001), age > 40 years (1.7 % vs 1.1 %, P < 0.01), and benign disease (1.7 % vs. 1.1 %, P < 0.01) were risk factors for ERCP related perforation. Most of the perforations
(n = 135, 79 %) were detected during the procedure. The majority of patients were
managed conservatively (n = 164, 96 %). Although 159 patients recovered, 12 patients
(7 %) did not survive. Completion of intended biliary procedure for primary disease
was associated with low risk of mortality (2 % vs 15.4 %, P < 0.001).
Conclusions ERCP related perforation is uncommon. The majority of patients can be managed conservatively.
The risk of mortality is low and completion of the intended biliary procedure decreases
the risk of mortality.
