Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement – Update 2020

Abstract

Summary of Recommendations 1 ESGE recommends that each center implements a written policy regarding the management of iatrogenic perforations, including the definition of procedures that carry a higher risk of this complication. This policy should be shared with the radiologists and surgeons at each center. 2 ESGE recommends that in the case of an endoscopically identified perforation, the endoscopist reports its size and location, with an image, and statement of the endoscopic treatment that has been applied. 3 ESGE recommends that symptoms or signs suggestive of iatrogenic perforation after an endoscopic procedure should be rapidly and carefully evaluated and documented with a computed tomography (CT) scan. 4 ESGE recommends that endoscopic closure should be considered depending on the type of the iatrogenic perforation, its size, and the endoscopist expertise available at the center. Switch to carbon dioxide (CO2) endoscopic insufflation, diversion of digestive luminal content, and decompression of tension pneumoperitoneum or pneumothorax should also be performed. 5 ESGE recommends that after endoscopic closure of an iatrogenic perforation, further management should be based on the estimated success of the endoscopic closure and on the general clinical condition of the patient. In the case of no or failed endoscopic closure of an iatrogenic perforation, and in patients whose clinical condition is deteriorating, hospitalization and surgical consultation are recommended.

A novel endoscopic purse-string suture technique, “loop 9”, for gastrointestinal defect closure: a pilot study

“…Various methods and devices for the endoscopic closure of GI defects have been studied, such as hemoclips, the combined use of hemoclips and supplementary devices, stapling devices, the over-the-scope clip system, and suturing devices [5]. Endoclips are still in common usage; however, they are limited to defects that are < 1 cm in size and linear in shape [6]. Matsuda et ▶ Fig.…”

Paradigm shift in management of acute iatrogenic colonic perforations: 24-year retrospective comprehensive study

“…All AIPs occurring during a colonoscopy and detected during or immediately (< 4 hous) after the procedure, were included in the study. Delayed perforations (> 4 hours after the procedure) 1 14 were excluded. Such cases were excluded per protocol since most of them usually require immediate surgical treatment.…”

“…Even though colonoscopy is considered to be a safe procedure, a number of serious complications such as acute iatrogenic perforations (AIPs), however small, may carry risks which are of great concern to endoscopists 1 . Indeed, having to face a new complication during treatment of the original case can be overwhelming.…”

Early Recognition and Management of Small Bowel Perforation

“…When contrast is contraindicated, then even plain CT is of help, in diagnosing perforation. The European Society of Gastrointestinal Endoscopy (ESGE) recommends that clinical features suggestive of perforation after an endoscopy should be rapidly and carefully evaluated and documented with a CT scan [26]. See flowchart for the diagnosis of intestinal perforation (Figure 5).…”