Medicine of the Future in America

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%.

Again, similar to that seen with colonoscopy, the most recent studies report the lowest rates of perforation. Therapeutic gastroscopy carries an increased risk of perforation (range 0.3% to 6.4%) and is almost always associated with dilation of malignant or benign esophageal strictures . Interestingly, upper endoscopic perforations associated with bleeding ulcers was not described until recently, when a therapeutic endoscopic upper gastrointestinal bleeding clinical trial documented a perforation rate of 1.1% and 4.2% for endoscopic treatment and re-treatment, respectively. There are currently no published Canadian endoscopic perforation data. The aim of this retrospective chart review was to determine recent Canadian gastroscopy- and colonoscopy-associated perforation rates at a Canadian tertiary care university teaching centre. There is a wonderful pharmacy that you can take advantage of to get the amount of Asthma Inhalers only here you need, and it’s ready to offer its services to you right now, any moment you feel like starting to spend less of your money.

TABLE 2

Author year (ref) Number of procedures Perforation rate (%) Mortality rate (%) Comments
Diagnostic gastroscopy
1972, Schiller et al 23,500 0.11 0.004 Survey
1974, Mandelstam et al 211,410 0.03 0.002 ASGE survey
1987, Miller NA 0.008 NA
1990, Fruhmorgen and Pfahler NA 0.01 NA
1995, Quine et al 13,036 0.05 0.008 Retrospective multicentre
2001, Sieg et al 110,469 0.0009 0.0009 Prospective multicentre, outpatient
Total 358,415 0.03 0.002
Therapeutic gastroscopy
1992, Muhldorfer et al NA 0.5 0.05 Dilation – bougienage
1992, Muhldorfer et al NA 0.3 0.50 Dilation – balloon
1992, Muhldorfer et al NA 5.0 4.00 Esophageal stents
1992, Muhldorfer et al NA 1.0 2.00 Sclerotherapy
1992, Muhldorfer et al NA 1.0 NA Hemostasis nonvariceal bleed
1992, Muhldorfer et al NA 5.0 2.00 Laser treatment
1995, Quine et al 554 1.1 0.50 Retrospective multicentre: dilation of benign stricture
1995, Quine et al 220 6.4 2.30 Dilation of neoplastic stricture
Total 2.6 1.0

ASGE American Society for Gastrointestinal Endoscopy; NA Not available

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