Objective:

To compare outcomes by initial management strategy for ERCP-related perforations, stratified by Stapfer type, and to describe contemporary non-surgical interventions, rescue surgery, and factors associated with failure.

Approach:

• Design: Systematic review and meta-analysis conducted according to PRISMA 2020 and prospectively registered in PROSPERO (CRD420251152632).
• Search and eligibility: MEDLINE, EMBASE, Scopus, and Web of Science were searched from inception through June 30, 2026. Eligible adult studies included at least six ERCP-related perforations and reported management and outcomes.
• Strategy classification: Patients were classified by the first definitive strategy after perforation identification. Patients initially managed non-surgically who later required surgery remained in that group and were counted as initial-strategy failures.
• Outcomes: The primary outcome was success of initial management, defined as discharge alive without rescue surgery after initial non-surgical care, or discharge alive after upfront surgery. Mortality and hospital length of stay were secondary outcomes.

Key Findings:

• The supplied context describes the review rationale and methods but provides no pooled results or quantitative findings.
• For Stapfer Types III–IV, surgical comparator data were too sparse for meaningful estimates of relative effects; outcomes were reported descriptively.

Interpretation:

The review was designed to compare initial treatment strategies while accounting for Stapfer subtype and treating later rescue surgery as failure of the initial non-surgical strategy.

Limitations:

• The available context does not include study counts, pooled estimates, or detailed results.
• The evidence base was described as predominantly small retrospective series, with clinical heterogeneity and limited representation of contemporary endoscopic techniques.
• English-language publication was required.