Abstract
BackgroundUpper gastrointestinal endoscopic examination is a relatively safe procedure; however, all endoscopic procedures are invasive and are associated with a risk of iatrogenic perforation. To evaluate clinical outcomes of iatrogenic upper gastrointestinal endoscopic perforation. Factors associated with surgical management or mortality were analyzed.MethodsBetween November 2008 and November 2018, the medical records of 149,792 upper gastrointestinal endoscopic procedures were evaluated. The mechanisms of perforations were categorized as electrocoagulation-induced or blunt trauma-induced injuries. The incidence and clinical outcomes of iatrogenic perforations based on the types of procedures performed were evaluated.ResultsIatrogenic endoscopic perforations occurred in 28 cases (0.019%). Iatrogenic perforation-related mortality occurred in 3 patients. The iatrogenic perforation rate based on the types of procedures performed was as follows: diagnostic endoscopy = 0.002%, duodenal endoscopic mucosal resection = 0.9%, esophageal endoscopic submucosal dissection = 10.7%, gastric endoscopic submucosal dissection = 0.2%, endoscopic self-expandable metal stent insertion for malignant esophageal obstruction = 0.1%, duodenoscope-induced injury = 0.02%, endoscopic sphincterotomy = 0.08%, and ampullectomy = 6.8%. All electrocoagulation-induced perforations (n = 21) were managed successfully (15 cases of endoscopic closure, 5 cases treated conservatively, and 1 case treated surgically). Three patients died among those with blunt trauma-induced perforations (n = 7). The factors associated with surgical management or mortality were old age, poor performance status (Eastern Cooperative Oncology Group score ≥ 1), advanced malignancy, and blunt trauma.ConclusionsMost cases of electrocoagulation-induced iatrogenic perforations can be treated using endoscopic clips. If endoscopic closure fails for blunt trauma-induced perforations, prompt surgical management is mandatory.
Highlights
Upper gastrointestinal endoscopic examination is a relatively safe procedure; all endoscopic procedures are invasive and are associated with a risk of iatrogenic perforation
No evidence-based guidelines are established for the management of iatrogenic endoscopic perforations because the choice of therapeutic modality used depends upon its availability in the hospital, physicians’ experience, anatomical sites of lesions, and the patients’ comorbidities
A total of 28 iatrogenic endoscopic perforations occurred during the study period (0.019%, 28/149,792)
Summary
Upper gastrointestinal endoscopic examination is a relatively safe procedure; all endoscopic procedures are invasive and are associated with a risk of iatrogenic perforation. Upper gastrointestinal endoscopic examination is considered a relatively safe procedure; iatrogenic endoscopic perforations may necessitate emergency operations and may rarely be fatal. The reported incidence of iatrogenic endoscopic perforations during diagnostic endoscopy is 0.0009–0.01% [2], the risk of perforation is increasing owing to procedural difficulties associated with endoscopy, anatomical sites of perforations, and endoscopists’ experience [3, 4]. Factors that determine the optimal management of a perforation are the mechanism of iatrogenic endoscopic perforation (electrocoagulation- or blunt trauma-induced injury), patients’ performance status, anatomical sites involved, and the surgeon’s experience. Knowledge of factors associated with surgical management and mortality are important to decide the optimal treatment modalities to manage iatrogenic endoscopic perforations
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