Adverse events associated with EGD and EGD-related techniques

Abstract

This document is intended to educate readers on the rates and predictors of adverse events (AEs) in patients who undergo EGD and EGD-related techniques. Our goal is to assist endoscopists in providing accurate, evidence-based, and up-to-date information on the rates of AEs to patients, caretakers, and trainees. The information provided should not be construed as encouraging or discouraging any particular treatment or technique. Clinical decision-making in any specific case involves a personalized and thorough analysis of the patient’s condition, available courses of action, local expertise, and the patient’s values and preferences. Therefore, certain clinical considerations could lead an endoscopist to take a course of action that varies from the guidance in this document. This document is an update of a previous guideline prepared by the Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy (ASGE) in 2013.1Early D.S. Acosta R.D. Chandrasekhara V. et al.Adverse events associated with EUS and EUS with FNA.Gastrointest Endosc. 2013; 77: 839-843Abstract Full Text Full Text PDF PubMed Scopus (135) Google Scholar EGD or upper GI endoscopy is one of the most commonly performed GI procedures, with annual volumes exceeding 7.4 million in the United States.2Peery A.F. Crockett S.D. Murphy C.C. et al.Burden and cost of gastrointestinal, liver, and pancreatic diseases in the United States: update 2021.Gastroenterology. 2022; 162: 621-644Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar Accurate estimates of the AE rates associated with the performance of EGD are difficult to summarize because of several limitations encountered in source data. Such limitations include variability in data collection and outcome definitions, inconsistent follow-up periods, and reliance on self-reporting, among others.3Ben-Menachem T. Decker G.A. Early D.S. et al.Adverse events of upper GI endoscopy.Gastrointest Endosc. 2012; 76: 707-718Abstract Full Text Full Text PDF PubMed Scopus (189) Google Scholar Despite these limitations, diagnostic EGD has generally been considered a safe procedure.3Ben-Menachem T. Decker G.A. Early D.S. et al.Adverse events of upper GI endoscopy.Gastrointest Endosc. 2012; 76: 707-718Abstract Full Text Full Text PDF PubMed Scopus (189) Google Scholar However, because of increasing patient complexity and constant evolution in therapeutic endoscopic techniques, contemporary updates to estimates of risk associated with EGD are necessary. This document provides a review of commonly encountered potential AEs associated with EGD and EGD-related techniques. A comprehensive electronic database search was executed with the help of an expert medical librarian. The search was designed to capture AEs associated with diagnostic EGD with or without biopsy sampling, EGD with management of foreign body impaction, EGD with dilation and/or stent placement, EGD with hemostasis, and EGD with placement of percutaneous gastric or enteral access. Other therapeutic maneuvers including EMR, endoscopic submucosal dissection,4Evans J.A. Early D.S. Chandrasekhara V. et al.ASGE Standards of Practice CommitteeThe role of endoscopy in the assessment and treatment of esophageal cancer.Gastrointest Endosc. 2013; 77: 328-334Abstract Full Text Full Text PDF PubMed Google Scholar radiofrequency ablation,5Wani S. Qumseya B. Sultan S. et al.ASGE Standards of Practice CommitteeEndoscopic eradication therapy for patients with Barrett's esophagus-associated dysplasia and intramucosal cancer.Gastrointest Endosc. 2018; 87: 907-931Abstract Full Text Full Text PDF PubMed Scopus (79) Google Scholar endoscopic suturing, peroral endoscopic myotomy,6Khashab M.A. Vela M.F. Thosani N. et al.ASGE guideline on the management of achalasia.Gastrointest Endosc. 2020; 91: 213-227Abstract Full Text Full Text PDF PubMed Scopus (66) Google Scholar antireflux endoscopy, and bariatric endoscopy7Evans J.A. Muthusamy V.R. Acosta R.D. et al.American Society for Gastrointestinal Endoscopy Standards of Practice CommitteeThe role of endoscopy in the bariatric surgery patient.Gastrointest Endosc. 2015; 81: 1063-1072Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar were not intended to be captured in this review, because of relative novelty of and/or widespread lack of familiarity with the technique or because of discussion in detail of the technique(s) in more relevant ASGE documents. An electronic search was performed in PubMed and MEDLINE (Ovid) for English-language citations of prospective, retrospective, and relevant studies published from 1966 to January 7, 2021 using the search methods detailed in Appendix 1 (available online at www.giejournal.org). In addition, we solicited expert endoscopists for any relevant studies published up to and beyond this date. All citations initially identified were imported into Covidence (Covidence, Melbourne, Australia), and all duplicates were removed. In parallel, bibliographies of selected citations were searched, ad hoc supplementary PubMed database searches were performed, and experts were consulted for any potential studies not identified by the electronic strategy. Studies were considered for inclusion if they reported the rates of any AE(s) during or after performance of EGD. Studies were generally considered for inclusion based on design, in the descending order of strength of evidence: systematic review and meta-analyses, randomized controlled trials, prospective observational studies, retrospective observational studies, and case series or reports, with study size, study quality, and publication date factoring into the decision. In the first round of screening, an author (N.C.-P.) screened titles and abstracts and assigned studies to a designation of “possibly include” or “exclude” considering the above criteria. Any abstract labeled with the decision to possibly include was included in the second round. After the title and abstract screen, we made the decision on whether to cite studies included in the second round in the final review document based on the above criteria. Data on AEs were then extracted from the full-text studies selected for inclusion and presented according to each EGD-related procedure type. The electronic search yielded 4623 initial citations after removal of duplicates. A review of the evidence for each major AE type is provided below, with a summary of AE rates provided in Table 1. Predictors of AEs were also synthesized and reported wherever possible.Table 1Summary of estimated common adverse event ranges for EGD, based on results from relevant studiesEGD typeBleedingPerforationInfectionOtherRisk factors for adverse eventsDiagnostic<.1%9Kim H.I. Yoon J.Y. Kwak M.S. et al.Gastrointestinal and nongastrointestinal complications of esophagogastroduodenoscopy and colonoscopy in the real world: a nationwide standard cohort using the common data model database.Gut Liver. 2021; 15: 569-578Crossref PubMed Scopus (1) Google Scholar<.01%9Kim H.I. Yoon J.Y. Kwak M.S. et al.Gastrointestinal and nongastrointestinal complications of esophagogastroduodenoscopy and colonoscopy in the real world: a nationwide standard cohort using the common data model database.Gut Liver. 2021; 15: 569-578Crossref PubMed Scopus (1) Google Scholar,19Johnson B. Basson M.D. Absence of complications after endoscopic mucosal biopsy.Dig Dis. 2018; 36: 328-332Crossref PubMed Scopus (0) Google Scholar<.3%22Wang P. Xu T. Ngamruengphong S. et al.Rates of infection after colonoscopy and osophagogastroduodenoscopy in ambulatory surgery centres in the USA.Gut. 2018; 67: 1626-1636Crossref PubMed Scopus (45) Google Scholar,23Nelson D.B. Infectious disease complications of GI endoscopy: Part I, endogenous infections.Gastrointest Endosc. 2003; 57: 546-556Abstract Full Text PDF PubMed Scopus (102) Google ScholarCardiopulmonary:<.1%9Kim H.I. Yoon J.Y. Kwak M.S. et al.Gastrointestinal and nongastrointestinal complications of esophagogastroduodenoscopy and colonoscopy in the real world: a nationwide standard cohort using the common data model database.Gut Liver. 2021; 15: 569-578Crossref PubMed Scopus (1) Google Scholar,28Goudra B. Nuzat A. Singh P.M. et al.Association between type of sedation and the adverse events associated with gastrointestinal endoscopy: an analysis of 5 years' data from a tertiary center in the USA.Clin Endosc. 2017; 50: 161-169Crossref PubMed Scopus (45) Google Scholar, 29Jun J. Han J.I. Choi A.L. et al.Adverse events of conscious sedation using midazolam for gastrointestinal endoscopy.Anesth Pain Med. 2019; 14: 401-406Crossref Google Scholar, 30Alshamsi F. Jaeschke R. Baw B. et al.Prophylactic endotracheal intubation in patients with upper gastrointestinal bleeding undergoing endoscopy: a systematic review and meta-analysis.Saudi J Med Med Sci. 2017; 5: 201-209Crossref PubMed Google Scholar, 31Olaiya B. Adler D.G. Air embolism secondary to endoscopy in hospitalized patients: results from the National Inpatient Sample (1998-2013).Ann Gastroenterol. 2019; 32: 476-481PubMed Google Scholar, 32Donepudi S. Chavalitdhamrong D. Pu L. et al.Air embolism complicating gastrointestinal endoscopy: a systematic review.World J Gastrointest Endosc. 2013; 5: 359-365Crossref PubMed Google ScholarBleeding: age ≥65 y9Kim H.I. Yoon J.Y. Kwak M.S. et al.Gastrointestinal and nongastrointestinal complications of esophagogastroduodenoscopy and colonoscopy in the real world: a nationwide standard cohort using the common data model database.Gut Liver. 2021; 15: 569-578Crossref PubMed Scopus (1) Google ScholarInfection: preceding hospitalization, preceding endoscopy, lower facility procedural volume22Wang P. Xu T. Ngamruengphong S. et al.Rates of infection after colonoscopy and osophagogastroduodenoscopy in ambulatory surgery centres in the USA.Gut. 2018; 67: 1626-1636Crossref PubMed Scopus (45) Google ScholarCardiopulmonary: age ≥65 y, obesity, hypertension, diabetes, coronary artery disease, recent acute myocardial infarction9Kim H.I. Yoon J.Y. Kwak M.S. et al.Gastrointestinal and nongastrointestinal complications of esophagogastroduodenoscopy and colonoscopy in the real world: a nationwide standard cohort using the common data model database.Gut Liver. 2021; 15: 569-578Crossref PubMed Scopus (1) Google Scholar,33Benson M. Hubers J. Caldis M. et al.Safety and efficacy of moderate sedation in super obese patients undergoing lower and upper GI endoscopy: a case-control study.Obes Surg. 2020; 30: 3466-3471Crossref PubMed Scopus (2) Google Scholar, 34Long Y. Liu H.H. Yu C. et al.Pre-existing diseases of patients increase susceptibility to hypoxemia during gastrointestinal endoscopy.PLoS One. 2012; 7: e37614Crossref PubMed Scopus (22) Google Scholar, 35Cena M. Gomez J. Alyousef T. et al.Safety of endoscopic procedures after acute myocardial infarction: a systematic review.Cardiol J. 2012; 19: 447-452Crossref PubMed Scopus (10) Google Scholar, 36Enestvedt B.K. Eisen G.M. Holub J. et al.Is the American Society of Anesthesiologists classification useful in risk stratification for endoscopic procedures?.Gastrointest Endosc. 2013; 77: 464-471Abstract Full Text Full Text PDF PubMed Scopus (67) Google ScholarManagement of foreign body or food impaction2.6%43Cha M.H. Sandooja R. Khalid S. et al.Complication rates in emergent endoscopy for foreign bodies under different sedation modalities: a large single-center retrospective review.World J Gastrointest Endosc. 2021; 13: 45-55Crossref PubMed Google Scholar.4%-3.3%41Melendez-Rosado J. Corral J.E. Patel S. et al.Esophageal food impaction: causes, elective intubation, and associated adverse events.J Clin Gastroenterol. 2019; 53: 179-183Crossref PubMed Scopus (5) Google Scholar,43Cha M.H. Sandooja R. Khalid S. et al.Complication rates in emergent endoscopy for foreign bodies under different sedation modalities: a large single-center retrospective review.World J Gastrointest Endosc. 2021; 13: 45-55Crossref PubMed Google Scholar,45Park J.H. Park C.H. Park J.H. et al.Review of 209 cases of foreign bodies in the upper gastrointestinal tract and clinical factors for successful endoscopic removal.Korean J Gastroenterol. 2004; 43: 226-233PubMed Google Scholar, 46Schupack D.A. Lenz C.J. Geno D.M. et al.The evolution of treatment and complications of esophageal food impaction.United Eur Gastroenterol J. 2019; 7: 548-556Crossref PubMed Scopus (10) Google Scholar, 47Sung S.H. Jeon S.W. Son H.S. et al.Factors predictive of risk for complications in patients with oesophageal foreign bodies.Dig Liver Dis. 2011; 43: 632-635Abstract Full Text Full Text PDF PubMed Scopus (83) Google Scholar, 48Weinstock L.B. Shatz B.A. Thyssen S.E. Esophageal food bolus obstruction: evaluation of extraction and modified push techniques in 75 cases.Endoscopy. 1999; 31: 421-425Crossref PubMed Scopus (46) Google ScholarAspiration pneumonia:1.8%-6.0%42Sengupta N. Tapper E.B. Corban C. et al.The clinical predictors of aetiology and complications among 173 patients presenting to the emergency department with oesophageal food bolus impaction from 2004-2014.Aliment Pharmacol Ther. 2015; 42: 91-98Crossref PubMed Scopus (24) Google Scholar,43Cha M.H. Sandooja R. Khalid S. et al.Complication rates in emergent endoscopy for foreign bodies under different sedation modalities: a large single-center retrospective review.World J Gastrointest Endosc. 2021; 13: 45-55Crossref PubMed Google ScholarCardiopulmonary:1.5%-4.4%39Ikenberry S.O. Jue T.L. Anderson M.A. et al.Management of ingested foreign bodies and food impactions.Gastrointest Endosc. 2011; 73: 1085-1091Abstract Full Text Full Text PDF PubMed Scopus (417) Google Scholar,41Melendez-Rosado J. Corral J.E. Patel S. et al.Esophageal food impaction: causes, elective intubation, and associated adverse events.J Clin Gastroenterol. 2019; 53: 179-183Crossref PubMed Scopus (5) Google ScholarBleeding: no use of cap-assisted technique44Ooi M. Duong T. Holman R. et al.Comparison of cap-assisted vs conventional endoscopic technique for management of food bolus impaction in the esophagus: results of a multicenter randomized controlled trial.Am J Gastroenterol. 2021; 116: 2235-2240Crossref PubMed Scopus (0) Google ScholarPerforation: esophageal location, longer time from impaction to EGD, foreign body size, bone41Melendez-Rosado J. Corral J.E. Patel S. et al.Esophageal food impaction: causes, elective intubation, and associated adverse events.J Clin Gastroenterol. 2019; 53: 179-183Crossref PubMed Scopus (5) Google Scholar,45Park J.H. Park C.H. Park J.H. et al.Review of 209 cases of foreign bodies in the upper gastrointestinal tract and clinical factors for successful endoscopic removal.Korean J Gastroenterol. 2004; 43: 226-233PubMed Google Scholar,47Sung S.H. Jeon S.W. Son H.S. et al.Factors predictive of risk for complications in patients with oesophageal foreign bodies.Dig Liver Dis. 2011; 43: 632-635Abstract Full Text Full Text PDF PubMed Scopus (83) Google ScholarDilationEsophageal:.1%-0.7%57Mullen M.B. Witt M.A. Stromberg A.J. et al.National database outcomes of esophageal dilations.Laryngoscope. 2021; 131: 2436-2440Crossref PubMed Scopus (0) Google Scholar,58Josino I.R. Madruga-Neto A.C. Ribeiro I.B. et al.Endoscopic dilation with bougies versus balloon dilation in esophageal benign strictures: systematic review and meta-analysis.Gastroenterol Res Pract. 2018; 2018: 5874870Crossref PubMed Scopus (29) Google Scholar,60Moawad F.J. Molina-Infante J. Lucendo A.J. et al.Systematic review with meta-analysis: endoscopic dilation is highly effective and safe in children and adults with eosinophilic oesophagitis.Aliment Pharmacol Ther. 2017; 46: 96-105Crossref PubMed Scopus (59) Google Scholar,75Moole H. Jacob K. Duvvuri A. et al.Role of endoscopic esophageal dilation in managing eosinophilic esophagitis: a systematic review and meta-analysis.Medicine (Baltimore). 2017; 96: e5877Crossref PubMed Scopus (16) Google Scholar,77Repici A. Jovani M. Hassan C. et al.Management of inoperable malignant oesophageal strictures with fully covered WallFlex(®) stent: a multicentre prospective study.Dig Liver Dis. 2014; 46: 1093-1098Abstract Full Text Full Text PDF PubMed Scopus (15) Google ScholarGastroduodenal:0.7%-7.0%61Kochhar R. Malik S. Gupta P. et al.Etiological spectrum and response to endoscopic balloon dilation in patients with benign gastric outlet obstruction.Gastrointest Endosc. 2018; 88: 899-908Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar, 62Maus M.K. Leers J. Herbold T. et al.Gastric outlet obstruction after esophagectomy: retrospective analysis of the effectiveness and safety of postoperative endoscopic pyloric dilatation.World J Surg. 2016; 40: 2405-2411Crossref PubMed Scopus (23) Google Scholar, 63Bettenworth D. Mücke M.M. Lopez R. et al.Efficacy of endoscopic dilation of gastroduodenal Crohn's disease strictures: a systematic review and meta-analysis of individual patient data.Clin Gastroenterol Hepatol. 2019; 17: 2514-2522Abstract Full Text Full Text PDF PubMed Scopus (23) Google ScholarPostsurgical:.1%-1.5%55Baumann A.J. Mramba L.K. Hawkins R.B. et al.Endoscopic dilation of bariatric RNY anastomotic strictures: a systematic review and meta-analysis.Obes Surg. 2018; 28: 4053-4063Crossref PubMed Scopus (7) Google Scholar,64Chang S.H. Popov V.B. Thompson C.C. Endoscopic balloon dilation for treatment of sleeve gastrectomy stenosis: a systematic review and meta-analysis.Gastrointest Endosc. 2020; 91: 989-1002Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar,65de Moura E.G.H. Orso I.R.B. Aurélio E.F. et al.Factors associated with complications or failure of endoscopic balloon dilation of anastomotic stricture secondary to Roux-en-Y gastric bypass surgery.Surg Obes Relat Dis. 2016; 12: 582-586Abstract Full Text Full Text PDF PubMed Scopus (14) Google ScholarEsophageal:.1%-.7%57Mullen M.B. Witt M.A. Stromberg A.J. et al.National database outcomes of esophageal dilations.Laryngoscope. 2021; 131: 2436-2440Crossref PubMed Scopus (0) Google Scholar,58Josino I.R. Madruga-Neto A.C. Ribeiro I.B. et al.Endoscopic dilation with bougies versus balloon dilation in esophageal benign strictures: systematic review and meta-analysis.Gastroenterol Res Pract. 2018; 2018: 5874870Crossref PubMed Scopus (29) Google Scholar,66Goyal A. Chatterjee K. Yadlapati S. et al.Health-care utilization and complications of endoscopic esophageal dilation in a national population.Clin Endosc. 2017; 50: 366-371Crossref PubMed Scopus (4) Google Scholar,67Grooteman K.V. Wong Kee Song L.M. Vleggaar F.P. et al.Non-adherence to the rule of 3 does not increase the risk of adverse events in esophageal dilation.Gastrointest Endosc. 2017; 85: 332-337Abstract Full Text Full Text PDF PubMed Scopus (39) Google ScholarPneumatic:2.0%-5.0%71van Hoeij F.B. Prins L.I. Smout A. et al.Efficacy and safety of pneumatic dilation in achalasia: a systematic review and meta-analysis.Neurogastroenterol Motil. 2019; 31: e13548Crossref PubMed Scopus (20) Google Scholar, 72Bonifácio P. de Moura D.T.H. Bernardo W.M. et al.Pneumatic dilation versus laparoscopic Heller's myotomy in the treatment of achalasia: systematic review and meta-analysis based on randomized controlled trials.Dis Esophagus. 2019; 32: 1-9Crossref Scopus (10) Google Scholar, 73Ghoshal U.C. Karyampudi A. Verma A. et al.Perforation following pneumatic dilation of achalasia cardia in a university hospital in northern India: a two-decade experience.Indian J Gastroenterol. 2018; 37: 347-352Crossref PubMed Scopus (5) Google Scholar, 74Katzka D.A. Castell D.O. An analysis of the efficacy, perforation rates and methods used in pneumatic dilation for achalasia [Review].Aliment Pharmacol Ther. 2011; 34: 832-839Crossref PubMed Scopus (68) Google ScholarGastroduodenal:1.5%-1.8%61Kochhar R. Malik S. Gupta P. et al.Etiological spectrum and response to endoscopic balloon dilation in patients with benign gastric outlet obstruction.Gastrointest Endosc. 2018; 88: 899-908Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar,63Bettenworth D. Mücke M.M. Lopez R. et al.Efficacy of endoscopic dilation of gastroduodenal Crohn's disease strictures: a systematic review and meta-analysis of individual patient data.Clin Gastroenterol Hepatol. 2019; 17: 2514-2522Abstract Full Text Full Text PDF PubMed Scopus (23) Google ScholarPostsurgical:.5%-2.3%55Baumann A.J. Mramba L.K. Hawkins R.B. et al.Endoscopic dilation of bariatric RNY anastomotic strictures: a systematic review and meta-analysis.Obes Surg. 2018; 28: 4053-4063Crossref PubMed Scopus (7) Google Scholar,64Chang S.H. Popov V.B. Thompson C.C. Endoscopic balloon dilation for treatment of sleeve gastrectomy stenosis: a systematic review and meta-analysis.Gastrointest Endosc. 2020; 91: 989-1002Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar,65de Moura E.G.H. Orso I.R.B. Aurélio E.F. et al.Factors associated with complications or failure of endoscopic balloon dilation of anastomotic stricture secondary to Roux-en-Y gastric bypass surgery.Surg Obes Relat Dis. 2016; 12: 582-586Abstract Full Text Full Text PDF PubMed Scopus (14) Google ScholarNot reportedNot applicableBleeding: male sex, Barrett’s esophagus, malignancy, caustic strictures57Mullen M.B. Witt M.A. Stromberg A.J. et al.National database outcomes of esophageal dilations.Laryngoscope. 2021; 131: 2436-2440Crossref PubMed Scopus (0) Google Scholar,61Kochhar R. Malik S. Gupta P. et al.Etiological spectrum and response to endoscopic balloon dilation in patients with benign gastric outlet obstruction.Gastrointest Endosc. 2018; 88: 899-908Abstract Full Text Full Text PDF PubMed Scopus (15) Google ScholarPerforation: male sex, age ≥70 y, head and neck malignancy, corrosive injury57Mullen M.B. Witt M.A. Stromberg A.J. et al.National database outcomes of esophageal dilations.Laryngoscope. 2021; 131: 2436-2440Crossref PubMed Scopus (0) Google Scholar,66Goyal A. Chatterjee K. Yadlapati S. et al.Health-care utilization and complications of endoscopic esophageal dilation in a national population.Clin Endosc. 2017; 50: 366-371Crossref PubMed Scopus (4) Google Scholar, 67Grooteman K.V. Wong Kee Song L.M. Vleggaar F.P. et al.Non-adherence to the rule of 3 does not increase the risk of adverse events in esophageal dilation.Gastrointest Endosc. 2017; 85: 332-337Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar, 68Hagel A.F. Naegel A. Dauth W. et al.Perforation during esophageal dilatation: a 10-year experience.J Gastrointestin Liver Dis. 2013; 22: 385-389PubMed Google Scholar, 69Moss W.J. Pang J. Orosco R.K. et al.Esophageal dilation in head and neck cancer patients: a systematic review and meta-analysis.Laryngoscope. 2018; 128: 111-117Crossref PubMed Scopus (18) Google Scholar, 70Chiu Y.C. Liang C.M. Tam W. et al.The effects of endoscopic-guided balloon dilations in esophageal and gastric strictures caused by corrosive injuries.BMC Gastroenterol. 2013; 13: 99Crossref PubMed Scopus (17) Google ScholarStent placementEsophageal:1.3%-3.7%77Repici A. Jovani M. Hassan C. et al.Management of inoperable malignant oesophageal strictures with fully covered WallFlex(®) stent: a multicentre prospective study.Dig Liver Dis. 2014; 46: 1093-1098Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar,78Włodarczyk J.R. Kużdżał J. Stenting in palliation of unresectable esophageal cancer.World J Surg. 2018; 42: 3988-3996Crossref PubMed Scopus (16) Google ScholarGastroduodenal:.8%-1.5%83van Halsema E.E. Rauws E.A. Fockens P. et al.Self-expandable metal stents for malignant gastric outlet obstruction: a pooled analysis of prospective literature.World J Gastroenterol. 2015; 21: 12468-12481Crossref PubMed Scopus (39) Google Scholar,84Costamagna G. Tringali A. Spicak J. et al.Treatment of malignant gastroduodenal obstruction with a nitinol self-expanding metal stent: an international prospective multicentre registry.Dig Liver Dis. 2012; 44: 37-43Abstract Full Text Full Text PDF PubMed Scopus (48) Google ScholarEsophageal:.9%-1.2%77Repici A. Jovani M. Hassan C. et al.Management of inoperable malignant oesophageal strictures with fully covered WallFlex(®) stent: a multicentre prospective study.Dig Liver Dis. 2014; 46: 1093-1098Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar,78Włodarczyk J.R. Kużdżał J. Stenting in palliation of unresectable esophageal cancer.World J Surg. 2018; 42: 3988-3996Crossref PubMed Scopus (16) Google Scholar,85Chandan S. Mohan B.P. Khan S.R. et al.Clinical efficacy and safety of palliative esophageal stenting without fluoroscopy: a systematic review and meta-analysis.Endosc Int Open. 2020; 8: E944-E952Crossref PubMed Google ScholarGastroduodenal:1.2%-1.4%82Jue T.L. Storm A.C. Naveen M. et al.ASGE Standards of Practice CommitteeASGE guideline on the role of endoscopy in the management of benign and malignant gastroduodenal obstruction.Gastrointest Endosc. 2021; 93: 309-322Abstract Full Text Full Text PDF Scopus (0) Google Scholar,87Ratone J.P. Caillol F. Zemmour C. et al.Outcomes of duodenal stenting: experience in a French tertiary center with 220 cases.Dig Liver Dis. 2020; 52: 51-56Abstract Full Text Full Text PDF PubMed Scopus (6) Google ScholarAspiration pneumonia:.5%-2.5%78Włodarczyk J.R. Kużdżał J. Stenting in palliation of unresectable esophageal cancer.World J Surg. 2018; 42: 3988-3996Crossref PubMed Scopus (16) Google Scholar,87Ratone J.P. Caillol F. Zemmour C. et al.Outcomes of duodenal stenting: experience in a French tertiary center with 220 cases.Dig Liver Dis. 2020; 52: 51-56Abstract Full Text Full Text PDF PubMed Scopus (6) Google ScholarEsophageal:4.1%-12.2% (migration, cancer),77Repici A. Jovani M. Hassan C. et al.Management of inoperable malignant oesophageal strictures with fully covered WallFlex(®) stent: a multicentre prospective study.Dig Liver Dis. 2014; 46: 1093-1098Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar,78Włodarczyk J.R. Kużdżał J. Stenting in palliation of unresectable esophageal cancer.World J Surg. 2018; 42: 3988-3996Crossref PubMed Scopus (16) Google Scholar28.6% (migration, benign),80Fuccio L. Hassan C. Frazzoni L. et al.Clinical outcomes following stent placement in refractory benign esophageal stricture: a systematic review and meta-analysis.Endoscopy. 2016; 48: 141-148PubMed Google Scholar2.4%-12.4% (occlusion)77Repici A. Jovani M. Hassan C. et al.Management of inoperable malignant oesophageal strictures with fully covered WallFlex(®) stent: a multicentre prospective study.Dig Liver Dis. 2014; 46: 1093-1098Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar,78Włodarczyk J.R. Kużdżał J. Stenting in palliation of unresectable esophageal cancer.World J Surg. 2018; 42: 3988-3996Crossref PubMed Scopus (16) Google ScholarGastroduodenal:4.3% (migration),83van Halsema E.E. Rauws E.A. Fockens P. et al.Self-expandable metal stents for malignant gastric outlet obstruction: a pooled analysis of prospective literature.World J Gastroenterol. 2015; 21: 12468-12481Crossref PubMed Scopus (39) Google Scholar12.6% (occlusion)82Jue T.L. Storm A.C. Naveen M. et al.ASGE Standards of Practice CommitteeASGE guideline on the role of endoscopy in the management of benign and malignant gastroduodenal obstruction.Gastrointest Endosc. 2021; 93: 309-322Abstract Full Text Full Text PDF Scopus (0) Google Scholar,83van Halsema E.E. Rauws E.A. Fockens P. et al.Self-expandable metal stents for malignant gastric outlet obstruction: a pooled analysis of prospective literature.World J Gastroenterol. 2015; 21: 12468-12481Crossref PubMed Scopus (39) Google ScholarStent migration: covered stents,79Wang C. Wei H. Li Y. Comparison of fully-covered vs partially covered self-expanding metallic stents for palliative treatment of inoperable esophageal malignancy: a systematic review and meta-analysis.BMC Cancer. 2020; 20: 73Crossref PubMed Scopus (5) Google Scholar stent for benign disease80Fuccio L. Hassan C. Frazzoni L. et al.Clinical outcomes following stent placement in refractory benign esophageal stricture: a systematic review and meta-analysis.Endoscopy. 2016; 48: 141-148PubMed Google ScholarStent occlusion: uncovered stents82Jue T.L. Storm A.C. Naveen M. et al.ASGE Standards of Practice CommitteeASGE guideline on the role of endoscopy in the management of benign and malignant gastroduodenal obstruction.Gastrointest Endosc. 2021; 93: 309-322Abstract Full Text Full Text PDF Scopus (0) Google ScholarHemostasis or prophylaxis of bleeding1.4% (with gluing)100Guo Y.W. Miao H.B. Wen Z.F. et al.Procedure-related complications in gastric variceal obturation with tissue glue.World J Gastroenterol. 2017; 23: 7746-7755Crossref PubMed Scopus (10) Google ScholarNot reportedAspiration pneumonia (with balloon tamponade):11.2%104Rodrigues S.G. Cárdenas A. Escorsell À. et al.Balloon tamponade and esophageal stenting for esophageal variceal bleeding in cirrhosis: a systematic review and meta-analysis.Semin Liver Dis. 2019; 39: 178-194Crossref PubMed Scopus (10) Google ScholarFever (with gluing):35.0%101Ríos Castellanos E. Seron P. Gisbert J.P. et al.Endoscopic injection of cyanoacrylate glue versus other endoscopic procedures for acute bleeding gastric varices in people with portal hypertension.Cochrane Database Syst Rev. 2015; Cd010180Crossref PubMed Scopus (69) Google ScholarStent migration (with variceal bleed):23.8%104Rodrigues S.G. Cárdenas A. Escorsell À. et al.Balloon tamponade and esophageal stenting for esophageal variceal bleeding in cirrhosis: a systematic review and meta-analysis.Semin Liver Dis. 2019; 39: 178-194Crossref PubMed Scopus (10) Google ScholarDysphagia or chest pain (with endoscopic band ligation):6.0%-23.0%104Rodrigues S.G. Cárdenas A. Escorsell À. et al.Balloon tamponade and esophageal stenting for esophageal variceal bleeding in cirrhosis: a systematic review and meta-analysis.Semin Liver Dis. 2019; 39: 178-194Crossref PubMed Scopus (10) Google