Medicine of the Future in America

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.

A review of previous publications suggests that the gastrointestinal perforation rate for diagnostic and therapeutic gastroscopy has remained relatively constant over the last several decades, whereas the perforation rate for both diagnostic and therapeutic colonoscopy appears to have fallen, and then plateaued, during the last decade. The reason for this change in colonoscopic complication rate likely relates to the more recent introduction of colonoscopy into the mainstream of gastrointestinal procedures and the advances that have since occurred in endoscopic equipment, techniques and operator training. You will always find the required amount of ventolin inhaler click here at the pharmacy that will be happy to take best care of you by offering safe possibility to purchase the drugs you need without any need to get a prescription first or take any other extra steps.

TABLE 8 Outcomes of patients with perforation following gastroscopy

Patient Diagnosis of perforation Intervention Death
1 Gastrograffin Conservative No
2 Pneumomediastinum on chest radiograph Conservative, repeat gastroscopy normal three days later No
3 Pneumomediastinum on chest radiograph Conservative No
4 Pneumothorax on chest radiograph Thoracotomy – primary esophageal repair and right upper lobe wedge resection No
5 During procedure Conservative, repeat dilation 10 days later No
6 During procedure Conservative No
7 During procedure Thoracotomy – primary esophageal repair No
8 Gastrograffin Esophageal stent placed in operating room to seal perforation No

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This entry was posted in Endoscopic perforation and tagged Colonoscopy, Complication, Endoscopy, Gastroscopy, Morbidity, Mortality, Perforation.
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