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Vol. 2 No. 2 (2025)

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Submitted
July 12, 2026
Published
December 31, 2025

Copyright (c) 2025 Nawal Ahmad Makeen Oqbi, Faraj Mohammed Shwaim Al Sakhabirah, Mohammed Abdullah Alotaibi, Ali Mohammed Mansour Mohammed, Mousa Ghaleb Khalil Alhadri, Hana Ali Hassan Gharawi, Mohsen Dughailib Ghazi Alotaibi, Norah Falah Alnawmasi, Abdulhadi Ahmed Mashragi, Fatimah Ali Nasser AlNasser

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This work is licensed under a Creative Commons Attribution 4.0 International License.

Endoscopic Retrograde Cholangiopancreatography-Associated Small Bowel Perforation: A Multidisciplinary Perspective on Clinical Management, Nursing Role, Patient Safety, and Health Informatics

https://doi.org/10.64483/202522738
Nawal Ahmad Makeen Oqbi
Al Wasli Primary Health Care Center,Ministry of Health, Saudi Arabia
Faraj Mohammed Shwaim Al Sakhabirah
Al Rawdah Primary Health Care Center, Al Aflaj,Ministry of Health , Saudi Arabia
Mohammed Abdullah Alotaibi
King Khaled Hospital, Majmaah,Ministry of Health , Saudi Arabia
Ali Mohammed Mansour Mohammed
Bisha General Hospital, Jazan,Ministry of Health , Saudi Arabia
Mousa Ghaleb Khalil Alhadri
Prince Mohammed bin Nasser Hospital, Jazan,Ministry of Health , Saudi Arabia
Hana Ali Hassan Gharawi
Al Eidabi General Hospital, Jazan,Ministry of Health , Saudi Arabia
Mohsen Dughailib Ghazi Alotaibi
Al Dawadmi General Hospital, Ministry of Health , Saudi Arabia
Norah Falah Alnawmasi
North of Riyadh Dental Clinic,Ministry of Health , Saudi Arabia
Abdulhadi Ahmed Mashragi
College of Pharmacy, Jazan University, Saudi Arabia
Fatimah Ali Nasser AlNasser
Diabetic Center Jazan,Ministry of Health , Saudi Arabia

Corresponding Author(s) : Nawal Ahmad Makeen Oqbi

Akrmesmail206@gmail.com

Saudi Journal of Medicine and Public Health, Vol. 2 No. 2 (2025)

Abstract

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is an essential minimally invasive procedure for the diagnosis and treatment of pancreaticobiliary disorders. Despite its high therapeutic success, ERCP is associated with potentially serious complications, including post-sphincterotomy bleeding, gastrointestinal perforation, and perforation secondary to biliary stent migration, which may require urgent surgical intervention and multidisciplinary management.


Aim: This narrative review aimed to summarize the current evidence regarding ERCP-related complications requiring surgical intervention, with emphasis on their incidence, diagnosis, classification, clinical presentation, management strategies, and multidisciplinary care.


Methods: A narrative review of published literature was conducted to evaluate the epidemiology, diagnostic approaches, endoscopic management, surgical indications, and outcomes of major ERCP-related complications. Relevant evidence addressing the roles of nursing, pharmacy, health professionals, and health informatics in patient management was also reviewed.


Results: Perforation occurs in approximately 0.4%–1.67% of ERCP procedures, with mortality reaching 8%, while biliary stent migration occurs in approximately 8.5% of cases, and intestinal perforation develops in nearly 1% of migrated stents. Post-sphincterotomy bleeding is primarily managed endoscopically, with surgery reserved for refractory cases. Early diagnosis through clinical assessment, laboratory investigations, and advanced imaging significantly improves outcomes. Multidisciplinary management supported by evidence-based endoscopic, surgical, and informatics-guided interventions enhances patient safety and reduces morbidity and mortality.


Conclusion: Early recognition, prompt intervention, and coordinated multidisciplinary care remain fundamental for improving outcomes in patients experiencing ERCP-related complications. Advances in endoscopic techniques and health informatics continue to reduce the need for surgery while optimizing patient-centered care.

Keywords

Endoscopic retrograde cholangiopancreatography; ERCP; Post-sphincterotomy bleeding; Gastrointestinal perforation; Biliary stent migration; Surgical management; Multidisciplinary care; Health informatics.
Oqbi, N. A. M., Faraj Mohammed Shwaim Al Sakhabirah, Mohammed Abdullah Alotaibi, Ali Mohammed Mansour Mohammed, Mousa Ghaleb Khalil Alhadri, Hana Ali Hassan Gharawi, … Fatimah Ali Nasser AlNasser. (2025). Endoscopic Retrograde Cholangiopancreatography-Associated Small Bowel Perforation: A Multidisciplinary Perspective on Clinical Management, Nursing Role, Patient Safety, and Health Informatics. Saudi Journal of Medicine and Public Health, 2(2), 3762–3772. https://doi.org/10.64483/202522738
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References
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  43. Yilmaz S, Ersen O, Ozkececi T, Turel KS, Kokulu S, Kacar E, Akici M, Cilekar M, Kavak O, Arikan Y. Results of the open surgery after endoscopic basket impaction during ERCP procedure. World J Gastrointest Surg. 2015;7:15–20. doi: 10.4240/wjgs.v7.i2.15.
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  47. Tsou YK, Lin CH, Liu NJ, Tang JH, Sung KF, Cheng CL, Lee CS. Treating delayed endoscopic sphincterotomy-induced bleeding: epinephrine injection with or without thermotherapy. World J Gastroenterol. 2009;15:4823–4828. doi: 10.3748/wjg.15.4823.
  48. Katsinelos P, Kountouras J, Chatzimavroudis G, Zavos C, Fasoulas K, Katsinelos T, Pilpilidis I, Paroutoglou G. Endoscopic hemostasis using monopolar coagulation for postendoscopic sphincterotomy bleeding refractory to injection treatment. Surg Laparosc Endosc Percutan Tech. 2010;20:84–88. doi: 10.1097/SLE.0b013e3181d76ace.
  49. Shimatani M, Tokuhara M, Okazaki K. Safe hemostasis method using newly developed hemoclip for post-endoscopic papillary large balloon dilation with sphincterotomy bleeding. Dig Endosc. 2020;32:e34–e35. doi: 10.1111/den.13576.
  50. Chon HK, Kim TH. Endoclip therapy of post-sphincterotomy bleeding using a transparent cap-fitted forward-viewing gastroscope. Surg Endosc. 2017;31:2783–2788. doi: 10.1007/s00464-016-5287-x.
  51. Goenka MK, Harwani Y, Rai V, Goenka U. Fully covered self-expandable metal biliary stent for hemobilia caused by portal biliopathy. Gastrointest Endosc. 2014;80:1175. doi: 10.1016/j.gie.2014.03.029.
  52. Conthe A, Nogales Ó, Martínez Flores C, García Lledó J, Rayón L, Pérez Carazo L, García Mulas S, López Ibáñez M, Aranda Hernández J, Merino B. Usefulness of fully covered self-expandable biliary metal stents for the treatment of post-sphyncterotomy ERCP bleeding. Rev Esp Enferm Dig. 2019;111:931–934. doi: 10.17235/reed.2019.6393/2019.
  53. Mutignani M, Seerden T, Tringali A, Feisal D, Perri V, Familiari P, Costamagna G. Endoscopic hemostasis with fibrin glue for refractory postsphincterotomy and postpapillectomy bleeding. Gastrointest Endosc. 2010;71:856–860. doi: 10.1016/j.gie.2009.12.024.
  54. Appleby VJ, Hutchinson JM, Beckett CJ, Moreea S. Use of the haemostatic agent TC-325 in the treatment of bleeding secondary to endoscopic retrograde cholangiopancreatography sphincterotomy. QJM. 2015;108:79–80. doi: 10.1093/qjmed/hcu135.
  55. Dunne R, McCarthy E, Joyce E, McEniff N, Guiney M, Ryan JM, Beddy P. Post-endoscopic biliary sphincterotomy bleeding: an interventional radiology approach. Acta Radiol. 2013;54:1159–1164. doi: 10.1177/0284185113491567.
  56. Sulkowski U, Kautz G, Nottberg H, Förster E. [Surgical therapy of hemorrhage after endoscopic sphincterotomy. Indications and technique] Chirurg. 1996;67:26–31.
  57. Sarli L, Porrini C, Costi R, Regina G, Violi V, Ferro M, Roncoroni L. Operative treatment of periampullary retroperitoneal perforation complicating endoscopic sphincterotomy. Surgery. 2007;142:26–32. doi: 10.1016/j.surg.2007.02.002.
  58. ASGE Standards of Practice Committee. Chandrasekhara V, Khashab MA, Muthusamy VR, Acosta RD, Agrawal D, Bruining DH, Eloubeidi MA, Fanelli RD, Faulx AL, Gurudu SR, Kothari S, Lightdale JR, Qumseya BJ, Shaukat A, Wang A, Wani SB, Yang J, DeWitt JM. Adverse events associated with ERCP. Gastrointest Endosc. 2017;85:32–47. doi: 10.1016/j.gie.2016.06.051.
  59. Howard TJ, Tan T, Lehman GA, Sherman S, Madura JA, Fogel E, Swack ML, Kopecky KK. Classification and management of perforations complicating endoscopic sphincterotomy. Surgery. 1999;126:658–63; discussion 664.
  60. Stapfer M, Selby RR, Stain SC, Katkhouda N, Parekh D, Jabbour N, Garry D. Management of duodenal perforation after endoscopic retrograde cholangiopancreatography and sphincterotomy. Ann Surg. 2000;232:191–198. doi: 10.1097/00000658-200008000-00007.
  61. Dahale AS, Srivastava S, Saluja SS, Sachdeva S, Dalal A, Varakanahalli S. Management of scope-induced type I duodenal perforations: Over-the-scope clip versus surgery. Indian J Gastroenterol. 2021;40:287–294. doi: 10.1007/s12664-021-01152-0.
  62. Vezakis A, Fragulidis G, Polydorou A. Endoscopic retrograde cholangiopancreatography-related perforations: Diagnosis and management. World J Gastrointest Endosc. 2015;7:1135–1141. doi: 10.4253/wjge.v7.i14.1135.
  63. Brown D, Naidu J, Thomas R. Bowel perforation: a 'not so rare' complication of biliary stent migration. ANZ J Surg. 2021;91:E784–E786. doi: 10.1111/ans.16902.
  64. Diller R, Senninger N, Kautz G, Tübergen D. Stent migration necessitating surgical intervention. Surg Endosc. 2003;17:1803–1807. doi: 10.1007/s00464-002-9163-5.
  65. Jadallah K, Alzubi B, Sweidan A, Almanasra AR. Intraperitoneal duodenal perforation secondary to early migration of biliary stent: closure with through-the-scope clip. BMJ Case Rep. 2019;12:e230324. doi: 10.1136/bcr-2019-230324.
  66. Anderson EM, Phillips-Hughes J, Chapman R. Sigmoid colonic perforation and pelvic abscess complicating biliary stent migration. Abdom Imaging. 2007;32:317–319. doi: 10.1007/s00261-006-9067-2.
  67. Namdar T, Raffel AM, Topp SA, Namdar L, Alldinger I, Schmitt M, Knoefel WT, Eisenberger CF. Complications and treatment of migrated biliary endoprostheses: a review of the literature. World J Gastroenterol. 2007;13:5397–5399. doi: 10.3748/wjg.v13.i40.5397.
  68. Wagemakers S, Ibelings M. [Colovesicular fistula after migration of a biliary stent] Ned Tijdschr Geneeskd. 2011;155:A3615.
  69. Bill JG, Smith Z, Brancheck J, Elsner J, Hobbs P, Lang GD, Early DS, Das K, Hollander T, Doyle MBM, Fields RC, Hawkins WG, Strasberg SM, Hammill C, Chapman WC, Edmundowicz S, Mullady DK, Kushnir VM. The importance of early recognition in management of ERCP-related perforations. Surg Endosc. 2018;32:4841–4849. doi: 10.1007/s00464-018-6235-8.
  70. Akimboye F, Lloyd T, Hobson S, Garcea G. Migration of endoscopic biliary stent and small bowel perforation within an incisional hernia. Surg Laparosc Endosc Percutan Tech. 2006;16:39–40. doi: 10.1097/01.sle.0000202198.74569.5a.
  71. .Siaperas P, Ioannidis A, Skarpas A, Angelopoulos A, Drikos I, Karanikas I. A rare cause for Hartmann's procedure due to biliary stent migration: A case report. Int J Surg Case Rep. 2017;31:83–85. doi: 10.1016/j.ijscr.2017.01.016.
  72. Duman AE, Yılmaz H, Hülagü S. Biliary stents are forgotten more frequently in elderly patients. Turk J Med Sci. 2021;51:3067–3072. doi: 10.3906/sag-2104-108.
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