{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T07:46:29Z","timestamp":1791963989430,"version":"4.3.4"},"reference-count":38,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:00:00Z","timestamp":1791849600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:00:00Z","timestamp":1791849600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Surg Endosc"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>ERCP-related perforation is uncommon but potentially fatal, and optimal initial management remains uncertain across Stapfer subtypes. We compared initial non-surgical management with upfront surgery overall and by Stapfer type, retaining patients requiring rescue surgery within their original strategy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Databases were searched to 30 June 2026. Treatment success was standardised as survival to discharge without operative rescue after initial non-surgical management and survival to discharge after upfront surgery. Random-effects risk ratios (RRs) were pooled overall and by Stapfer type; certainty was assessed using GRADE.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Twenty-three retrospective studies included 681 perforations. In 15 reconstructable cohorts, initial-strategy success was 227\/273 (83.2%) after initial non-surgical management and 75\/89 (84.3%) after upfront surgery (RR 0.97, 95% CI 0.81\u20131.17;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u00a0=\u00a025%). Mortality was 16\/273 (5.9%) vs. 14\/89 (15.7%) (RR 0.53, 95% CI 0.25\u20131.15). Length of stay was heterogeneous and clinically inconclusive (MD 1.03\u00a0days, 95% CI \u2212\u00a03.35 to 5.40;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u00a0=\u00a083%; prediction interval \u2212\u00a011.24 to 13.30). Type I success (RR 1.04, 95% CI 0.77\u20131.41) and mortality (RR 1.47, 95% CI 0.56\u20133.86) were non-significant. Contemporary endoscopic closure succeeded in 10\/10 highly selected Type I cases (100%; exact 95% CI 69.2\u2013100.0%), but was too small to establish superiority. Type II success (RR 0.69, 95% CI 0.41\u20131.16) and mortality (RR 1.44, 95% CI 0.23\u20138.90) were also non-significant. Type III and IV non-surgical success was 46\/49 (93.9%) and 34\/34 (100%). Rescue surgery occurred in 14.3, 12.9, 5.4, and 0% of Types I\u2013IV. Certainty was very low.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Very-low-certainty evidence suggests management should be tailored to Stapfer subtype, physiological stability and source control, with prompt operative rescue when non-surgical management fails.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00464-026-13504-y","type":"journal-article","created":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:55:48Z","timestamp":1791939348000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Initial non-surgical versus upfront surgical management of ERCP-related perforations by Stapfer type: a systematic review and meta-analysis"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1006-9824","authenticated-orcid":false,"given":"Eyad","family":"Jamileh","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar","family":"Farooq","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Xamza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daren","family":"Subar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joel","family":"Lambert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,13]]},"reference":[{"issue":"2","key":"13504_CR1","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1053\/j.gastro.2025.03.009","volume":"169","author":"M Barakat","year":"2025","unstructured":"Barakat M, Saumoy M, Forbes N, Elmunzer BJ (2025) Complications of endoscopic retrograde cholangiopancreatography. 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