Medicine of the Future in America

Category Archives: Endoscopic perforation

Endoscopic perforation rates: CONCLUSION

The involvement of trainees as a significant factor in endoscopic perforation has not been previously confirmed . The current study had trainees involved in a minority of the cases; however, it was similarly impossible to determine the risk associated with trainees in that the total number of endoscopic cases the trainees were involved in was not determined. Nevertheless, operator training and experience has been clearly shown to correlate with endoscopic adverse events, including perforation. Continue reading

Endoscopic perforation rates: DISCUSSION (Part 2)

Perforation at gastroscopyNevertheless, in these same reported cohorts it is interesting to note that the average rate of perforation is approximately 85-fold higher for therapeutic gastroscopy (approximately 2.6%) than for diagnostic gastroscopy (approximately 0.03%); and threefold higher for therapeutic colonoscopy (approximately 0.24%) than for diagnostic colonoscopy (approximately 0.09%); while mortality is approximately 500-fold higher for therapeutic gastroscopy (approximately 1.0%) than for diagnostic gastroscopy (approximately 0.002%); and 50-fold higher for therapeutic colonoscopy (approximately 0.03%) than for diagnostic colonoscopy (approximately 0.006%). Continue reading

Endoscopic perforation rates: DISCUSSION (Part 1)

Like colonoscopy, the management of perforation following gastroscopy varied considerably (Table 8). The diagnosis of perforation was made during the procedure in three of the cases, and on x-ray, immediately following the procedure, in five of the cases (chest x-ray, three patients, gastrograffin swallow, two patients) Five patients were managed conservatively, one had an esophageal stent placed in the operating room to seal the perforation, and two underwent thoracotomies for esophageal repair. The surgically managed patients were discharged from hospital within 11 days of admission. Continue reading

Endoscopic perforation rates: Gastroscopy

upper gastrointestinal perforationsEight upper gastrointestinal perforations occurred during the 13,392 gastroscopies, representing a perforation rate of 0.06% (incidence, 0.6/1000; 1.0/1667 procedures). No gastroscopy-associated perforations occurred during 8062 diagnostic gastroscopies (0%), while eight gastroscopy-associated perforations occurred during 5330 therapeutic gastroscopies (0.15%) (incidence, 1.5/1000; 1/667 procedures).

Table 7 demonstrates the characteristics of the patients with a perforation during gastroscopy. The mean age of the patients involved was 62.4±8.2 years with a male:female ratio of 5:3. Continue reading

Endoscopic perforation rates: Colonoscopy (Part 2)

Three of 10 (30%) perforations (two therapeutic and one diagnostic colonoscopy) occurred because the colonoscopy was performed in a poorly prepped colon, although the state of the preparation was not reported in four of the perforations, perhaps underestimating the importance of adequate preparation in risk of perforation. Trainees were performing the colonoscopy at the time of perforation in four of 10 (40%) of the cases (four diagnostic colonoscopies). Continue reading

Endoscopic perforation rates: Colonoscopy (Part 1)

colonic perforationsTen colonic perforations occurred during the 7425 colonoscopies, representing an overall colonoscopic perforation rate of 0.13% (incidence, 1.3/1000; 1/769 procedures). Six colonoscopy-associated perforations occurred during 4470 diagnostic colonoscopies (0.13%) (incidence, 1.3/1000; 1/769 procedures), while four colonoscopy-associated perforations occurred during 2955 therapeutic colonoscopies (0.14%) (incidence, 1.4/1000; 1/714 procedures). Continue reading

Endoscopic perforation rates: RESULTS

Identified records were retrieved and hand searched to confirm an endoscopic-associated perforation by consensus of two authors (TM and RF). Data were extracted to identify patient demographics, endoscopic indication and diagnosis, type of procedure, extent of insertion, preparation adequacy, trainee involvement, previous abdominal surgery, renal failure, surgical outcome and mortality. The type of procedure was recorded as either diagnostic or therapeutic depending on the presence or absence of a therapeutic endoscopic maneuver. For gastroscopy, therapeutic maneuvers included dilation, stent placement, variceal and nonvariceal hemostatic procedures, and percutaneous endoscopic gastrostomy tube placement. For colonoscopy, therapeutic maneuvers included all therapeutic procedures identified for gastroscopy, plus polypectomy and decompression. The occurrence of mucosal biopsy was recorded as a diagnostic procedure. Continue reading

Endoscopic perforation rates: METHODS

hospitalThe University of Alberta Hospital is a university teaching centre and a tertiary care referral hospital located in Edmonton, Alberta. It serves a catchment area of over 1.8 million people from central/northern Alberta, northwestern Saskatchewan, northern British Columbia and the Northwest Territories. Endoscopy at the University of Alberta Hospital is performed by three pediatric gastroenterologists, four hepatologists, six adult gastroenterologists and one general surgeon. Approximately 4500 gastroscopies and 2500 colonoscopies are performed annually. The hospital also serves as a Canadian training centre for between five to 10 gastroenterology subspecialty residents in any given year. Continue reading

Endoscopic perforation rates (Part 2)

Indeed, a recent diagnostic colonoscopic screening program for colon cancer in a healthy population involving over 3000 colonoscopies had a zero rate of perforation , implying the risk of colonoscopy-associated perforation may be lowest during screening of a healthy outpatient population. Table 2 outlines the published reports of gastroscopy-associated perforation rates during the last 30 years. The rate of perforation with diagnostic gastroscopy has been described as lower than that of perforation associated with diagnostic colonoscopy. The rate of perforation at the time of diagnostic gastroscopy ranges from 0.0009% to 0.10%. Continue reading

Endoscopic perforation rates (Part 1)

Upper and lower flexible endoscopyUpper and lower flexible endoscopy has evolved into an important diagnostic and therapeutic tool that has revolutionized the management of patients with gastrointestinal diseases. Although flexible upper and lower endoscopy, with current endoscopic equipment and appropriate training is considered a safe procedure, like all other procedures in medicine, there remains identifiable potential for adverse events and complications. One of the most serious of these complications is intestinal perforation. Continue reading

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