Objective To analyze operative outcomes of endoscopic retrograde cholangiopancreatography (ERCP) rela-ted duodenal perforations. Methods Retrospective analysis was performed with the clinical data of 14 patients who had duodenal perforation during ERCP including 13 cases in Ruijin Hospital and one case in Ruijin Hospital North from Ja-nuary 2011 to May 2014. Surgical timing and procedure were analyzed. Duodenal perforations were classified into types according to Stapfer. Results There were type Ⅰ lesions in 2 cases, type Ⅱ lesions in 10 cases,and type Ⅲ lesions in 2 cases. The time to operation was during ERCP of type Ⅰ injuries, (2.0±1.1) (0-5.0) d of type Ⅱ injuries, and (6.0±2.8) (4.0-8.0) d of type Ⅲ injuries after ERCP with significant statistical difference (P<0.05), indicating different progress to abdominal infection from type Ⅰ, type Ⅱ, and type Ⅲ perforation. There were 3 cases of type Ⅱ perforation who had operation of duodenal diverticulation with two cases cured and one case died. No significant difference was present in hospital stay and mortality of the patients of type Ⅱ between 3 cases treated by duodenal diverticulation and 7 cases without duodenal diverticulation (P=0.451,P=0.300). Hospital stay of type Ⅰ, type Ⅱ, type Ⅲ was (49.0±32.5) d, (81.6±30.0) d, (51.0±22.6) d respectively without significant difference (P=0.239). Two cases 80 year and 86 year died had ampullary cancer, who were elder than cured cases (60~76) y with significant statistical difference (P<0.05). Conclusions Operation remains an important treatment for ERCP-related duodenal perforation. Optimal operation based on the type of ERCP related perforation and abdominal infection could be the key to affect efficacy. Elder patients with malignant tumor have poorer prognosis.