Medicine of the Future in America

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.

Table 1 outlines the published reports of colonoscopy-associated perforation rates during the last 30 years. The reported rate of colonic perforation ranges from a high of 1.3% to a low of 0% . Studies with the highest reported rate of perforations are those conducted at a time when colonoscopy was a relatively new procedure, and may not be representative of current colonoscopic practice. In contrast, retrospective and prospective studies conducted since 1996 have reported lower rates of perforation, with diagnostic colonoscopic perforation rates ranging from 0.005% to 0.20% and therapeutic colonoscopic perforation rates ranging from 0.06 to 0.40%. You will love this opportunity to shop with best pharmacy on the internet and pay less every time you visit: Buy Asthma Inhalers Online click here to discover exactly how much less you could be spending while still getting your treatment exactly the way you need it.

TABLE 1

Author year (ref) Number of procedures Perforation rate (%) Mortality rate (%) Comments
Diagnostic colonoscopy
1975, Rogers et al 25,298 0.22 0.008 ASGE survey
1976, Smith 12,746 0.26 0.016 Survey
1979, Fruhmorgen and Demling 28,527 0.14 0.020 Multicentre survey article
1979, Stuart et al 442 1.30 0.200 Retrospective single centre
1983, Macrae et al 3205 0.12 0 Retrospective single centre
1984, Gilbert et al 4713 0.17 NA ASGE survey
1990, Fruhmorgen and Pfahler 6609 0.05 0.015 Retrospective single centre
1992, Reed et al 1000 0.12 0 General surgeon survey
1992, Waye et al 1320 0 0 Ambulatory office procedures,
1996, Puchner et al 8989 0.08 0 prospective single endoscopist Retrospective single centre
1999, Eckardt et al 2500 0.04 0
2000, Anderson et al 6291 0.19 0 Retrospective single centre
2001, Sieg et al 82,416 0.005 0.001 Prospective multicentre
2001, Dafnis et al 4677 0.11 0 outpatients only Retrospective multicentre
2001, Wexner et al 13,580 0.07 NA Prospective general surgeons
Total 202,313 0.09 0.006
Therapeutic colonoscopy
1975, Rogers et al 6214 0.29 0 ASGE survey
1976, Smith 9238 0.52 0.01 Polypectomy-associated
1979, Stuart et al 184 0 0 Polypectomy-associated
1979, Fruhmorgen and Demling 7365 0.34 0.10 Polypectomy-associated
1983, Macrae et al 1795 0.11 0 Polypectomy-associated
1984, Gilbert et al 1901 0.11 NA Polypectomy-associated
1988, Nivatvongs 1576 0.06 0 Polypectomy-associated
1990, Fruhmorgen anf Pfahler 2306 0.20 0 Polypectomy-associated
1992, Waye et al 777 0.30 0 Polypectomy-associated
1996, Puchner et al 1609 0.20 0.20 Polypectomy-associated
1996, Kewenter and Brevinge 513 0.80 0 Polypectomy-associated
2000, Anderson et al 4195 0.19 0.05 Polypectomy-associated
2001, Sieg et al 14,249 0.06 0.007 Polypectomy-associated
2001, Dafnis et al 1389 0.22 0 Two-thirds polypectomy-
Total 53,311 0.24 0.03 associated

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