Management of Stapfer Type II Perforations After Endoscopic Retrograde Cholangiopancreatography: A Retrospective Study.

Objective: Stapfer type II perforations are serious, rare complications associated with endoscopic retrograde cholangiopancreatography (ERCP). Controversies remain in the literature regarding the optimal management of these perforations. The aim of this study was to evaluate different management approaches for this complication. Materials and Methods: In this retrospective study, data were collected from the medical records of adult patients treated for Stapfer type II perforations. Variables evaluated included demographics, ERCP indication, time to diagnosis and surgery, methods of management, length of hospital stay, and patient outcomes. Results: Twenty-three patients were included in the study, with a mean (± standard deviation, SD) age of 54.8 (±11.1) years. The indications for ERCP were choledocholithiasis (n=17), suspected sphincter of Oddi dysfunction (n=5), and biliary fistula after cholecystectomy (n=1). Perforation was diagnosed on the day of the procedure in 12 patients (52.2%). Fifteen patients (65.2%) were managed surgically. Time to surgery was significantly correlated with the length of hospital stay. Three patients in the non-surgical group died, while there were no mortalities in the surgical group. Conclusion: Patients with ERCP-related type II perforations can initially be treated non-surgically. However, clinicians must remain vigilant for failure of non-surgical management, and treatment approaches should be individualized based on the patient's clinical condition. Surgical intervention should be considered with appropriate patient selection and timing.