Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) has become an essential treatment modality for managing biliary and pancreatic disorders. However, perforation remains one of the most concerning complications associated with ERCP and endoscopic sphincterotomy. While the incidence of perforation following ERCP is relatively low, the associated mortality rate can reach 7.8%. Diagnosis and management of perforations depend on the injury's mechanism, location, and extent, as clinical and radiographic findings suggest. This paper provides a detailed overview of the causes, classification, diagnosis, management, and prevention strategies for ERCP-related perforations.