| Theme |
Perforation and it's Management in Endoscopy |
| Title |
Iatrogenic Perforations of Upper Gastrointestinal Tract during Insertion of Endoscope : Diagnosis and Management |
| Author |
Yasuaki Motomura |
Department of Gastroenterology, Aso Iizuka Hospital |
| Author |
Kazuya Akahoshi |
Department of Gastroenterology, Aso Iizuka Hospital |
| Author |
Naomi Higuchi |
Department of Gastroenterology, Aso Iizuka Hospital |
| Author |
Masaru Kubokawa |
Department of Gastroenterology, Aso Iizuka Hospital |
| [ Summary ] |
Iatrogenic upper gastrointestinal perforations during insertion of endoscopes are one of the most serious complications of endoscopic examinations. This complication occures at well determined rates. It may happen in the hypopharynx or the cervical esophagus. It can also occur in the second portion of the duodenum during ERCP. Several factors such as the endoscopist's skill level, patient related issues, and trouble with endoscopic instruments may be involved in the occurrence of iatrogenic perforation. The most important factor to avoid this complication is gentle manipulation of the endoscope. Easing the tension of patients and checking endoscopic instruments prior to examinations can also reduce the risk of perforations. Endoscopists should be careful not to miss signs of perforation during the examinations. Early diagnosis and adequate management is required to improve prognoses. Informed consent including mention of the risk of perforation prior to examinations and detailed examination of patients when perforation occurs is indispensable. Conservative treatment consisting of antibiotics and parental nutrition with or without endoscopic repair of the perforation, using hemoclips may be effective for limited injuries and minimal contamination. Surgical management with drainage is however the treatment of choice. |