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Clinical outcomes of iatrogenic upper gastrointestinal endoscopic perforation: a 10-year study

BACKGROUND: Upper 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 assoc...

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Autores principales: Kang, Dae Hwan, Ryu, Dae Gon, Choi, Cheol Woong, Kim, Hyung Wook, Park, Su Bum, Kim, Su Jin, Nam, Hyeong Seok
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6916018/
https://www.ncbi.nlm.nih.gov/pubmed/31842778
http://dx.doi.org/10.1186/s12876-019-1139-1
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author Kang, Dae Hwan
Ryu, Dae Gon
Choi, Cheol Woong
Kim, Hyung Wook
Park, Su Bum
Kim, Su Jin
Nam, Hyeong Seok
author_facet Kang, Dae Hwan
Ryu, Dae Gon
Choi, Cheol Woong
Kim, Hyung Wook
Park, Su Bum
Kim, Su Jin
Nam, Hyeong Seok
author_sort Kang, Dae Hwan
collection PubMed
description BACKGROUND: Upper 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. METHODS: Between 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. RESULTS: Iatrogenic 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. CONCLUSIONS: Most 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.
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spelling pubmed-69160182019-12-30 Clinical outcomes of iatrogenic upper gastrointestinal endoscopic perforation: a 10-year study Kang, Dae Hwan Ryu, Dae Gon Choi, Cheol Woong Kim, Hyung Wook Park, Su Bum Kim, Su Jin Nam, Hyeong Seok BMC Gastroenterol Research Article BACKGROUND: Upper 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. METHODS: Between 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. RESULTS: Iatrogenic 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. CONCLUSIONS: Most 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. BioMed Central 2019-12-16 /pmc/articles/PMC6916018/ /pubmed/31842778 http://dx.doi.org/10.1186/s12876-019-1139-1 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Kang, Dae Hwan
Ryu, Dae Gon
Choi, Cheol Woong
Kim, Hyung Wook
Park, Su Bum
Kim, Su Jin
Nam, Hyeong Seok
Clinical outcomes of iatrogenic upper gastrointestinal endoscopic perforation: a 10-year study
title Clinical outcomes of iatrogenic upper gastrointestinal endoscopic perforation: a 10-year study
title_full Clinical outcomes of iatrogenic upper gastrointestinal endoscopic perforation: a 10-year study
title_fullStr Clinical outcomes of iatrogenic upper gastrointestinal endoscopic perforation: a 10-year study
title_full_unstemmed Clinical outcomes of iatrogenic upper gastrointestinal endoscopic perforation: a 10-year study
title_short Clinical outcomes of iatrogenic upper gastrointestinal endoscopic perforation: a 10-year study
title_sort clinical outcomes of iatrogenic upper gastrointestinal endoscopic perforation: a 10-year study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6916018/
https://www.ncbi.nlm.nih.gov/pubmed/31842778
http://dx.doi.org/10.1186/s12876-019-1139-1
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