Esophagogastroduodenoscopy-associated gastrointestinal perforations

A single-center experience

Amit Merchea, Daniel C. Cullinane, Mark D Sawyer, Corey W. Iqbal, Todd H. Baron, Dennis A Wigle, Michael G. Sarr, Martin D. Zielinski

Research output: Contribution to journalArticle

53 Citations (Scopus)

Abstract

Background: Esophagogastroduodenoscopy (EGD) is commonly used in the diagnosis and treatment of gastrointestinal (GI) disorders. Our aim was to define the risk of perforation associated with EGD and identify patients who required operative intervention. Methods: We retrospectively reviewed 72 patients from our institution plus 5 transferred patients who sustained EGD-associated perforations from January 1996 through July 2008. Percutaneous endoscopic gastrostomy, endoscopic ultrasonography, endoscopic retrograde cholangiopancreatography, transthoracic echocardiography, and concurrent colonoscopy procedures were excluded. Results: Perforations in 72 of 217,507 EGD procedures were identified (incidence, 0.033%); 124,844 EGDs included an interventional procedure and 92,663 were examination only. The incidence of perforation was similar whether an interventional procedure was performed or not (0.040% vs 0.029%; P = .181). The esophagus was injured most commonly (51%), followed by the duodenum (32%), jejunum (6%), stomach (3%), and common bile duct (3%). Overall mortality after perforation was 17% with a morbidity rate of 40%. Thirty-eight patients (49%) were initially treated nonoperatively, 7 of whom (18%) failed nonoperative management. The only factors we could determine that were associated with failure were free fluid or contrast extravasation on computed tomography (75% vs 23% [P < .005] and 33% vs 0% [P = .047], respectively). The morbidity of failures was equivalent to those who underwent initial operative management (63% vs 61%; P = .917), with mortality seeming to be greater (43% vs 21%; P = .09). Conclusion: EGD is safe in the majority of patients; however, iatrogenic perforation is associated with considerable morbidity and mortality. Nonoperative management of GI perforation can be successful if there is no evidence of contrast extravasation or free fluid on radiographic studies. If nonoperative management fails, the outcomes may be worse than those treated initially with operative repair.

Original languageEnglish (US)
Pages (from-to)876-882
Number of pages7
JournalSurgery
Volume148
Issue number4
DOIs
StatePublished - Oct 2010

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Digestive System Endoscopy
Morbidity
Mortality
Endosonography
Gastrostomy
Endoscopic Retrograde Cholangiopancreatography
Incidence
Common Bile Duct
Jejunum
Colonoscopy
Duodenum
Esophagus
Echocardiography
Stomach
Tomography

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

Cite this

Esophagogastroduodenoscopy-associated gastrointestinal perforations : A single-center experience. / Merchea, Amit; Cullinane, Daniel C.; Sawyer, Mark D; Iqbal, Corey W.; Baron, Todd H.; Wigle, Dennis A; Sarr, Michael G.; Zielinski, Martin D.

In: Surgery, Vol. 148, No. 4, 10.2010, p. 876-882.

Research output: Contribution to journalArticle

Merchea, A, Cullinane, DC, Sawyer, MD, Iqbal, CW, Baron, TH, Wigle, DA, Sarr, MG & Zielinski, MD 2010, 'Esophagogastroduodenoscopy-associated gastrointestinal perforations: A single-center experience', Surgery, vol. 148, no. 4, pp. 876-882. https://doi.org/10.1016/j.surg.2010.07.010
Merchea, Amit ; Cullinane, Daniel C. ; Sawyer, Mark D ; Iqbal, Corey W. ; Baron, Todd H. ; Wigle, Dennis A ; Sarr, Michael G. ; Zielinski, Martin D. / Esophagogastroduodenoscopy-associated gastrointestinal perforations : A single-center experience. In: Surgery. 2010 ; Vol. 148, No. 4. pp. 876-882.
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abstract = "Background: Esophagogastroduodenoscopy (EGD) is commonly used in the diagnosis and treatment of gastrointestinal (GI) disorders. Our aim was to define the risk of perforation associated with EGD and identify patients who required operative intervention. Methods: We retrospectively reviewed 72 patients from our institution plus 5 transferred patients who sustained EGD-associated perforations from January 1996 through July 2008. Percutaneous endoscopic gastrostomy, endoscopic ultrasonography, endoscopic retrograde cholangiopancreatography, transthoracic echocardiography, and concurrent colonoscopy procedures were excluded. Results: Perforations in 72 of 217,507 EGD procedures were identified (incidence, 0.033{\%}); 124,844 EGDs included an interventional procedure and 92,663 were examination only. The incidence of perforation was similar whether an interventional procedure was performed or not (0.040{\%} vs 0.029{\%}; P = .181). The esophagus was injured most commonly (51{\%}), followed by the duodenum (32{\%}), jejunum (6{\%}), stomach (3{\%}), and common bile duct (3{\%}). Overall mortality after perforation was 17{\%} with a morbidity rate of 40{\%}. Thirty-eight patients (49{\%}) were initially treated nonoperatively, 7 of whom (18{\%}) failed nonoperative management. The only factors we could determine that were associated with failure were free fluid or contrast extravasation on computed tomography (75{\%} vs 23{\%} [P < .005] and 33{\%} vs 0{\%} [P = .047], respectively). The morbidity of failures was equivalent to those who underwent initial operative management (63{\%} vs 61{\%}; P = .917), with mortality seeming to be greater (43{\%} vs 21{\%}; P = .09). Conclusion: EGD is safe in the majority of patients; however, iatrogenic perforation is associated with considerable morbidity and mortality. Nonoperative management of GI perforation can be successful if there is no evidence of contrast extravasation or free fluid on radiographic studies. If nonoperative management fails, the outcomes may be worse than those treated initially with operative repair.",
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AU - Merchea, Amit

AU - Cullinane, Daniel C.

AU - Sawyer, Mark D

AU - Iqbal, Corey W.

AU - Baron, Todd H.

AU - Wigle, Dennis A

AU - Sarr, Michael G.

AU - Zielinski, Martin D.

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N2 - Background: Esophagogastroduodenoscopy (EGD) is commonly used in the diagnosis and treatment of gastrointestinal (GI) disorders. Our aim was to define the risk of perforation associated with EGD and identify patients who required operative intervention. Methods: We retrospectively reviewed 72 patients from our institution plus 5 transferred patients who sustained EGD-associated perforations from January 1996 through July 2008. Percutaneous endoscopic gastrostomy, endoscopic ultrasonography, endoscopic retrograde cholangiopancreatography, transthoracic echocardiography, and concurrent colonoscopy procedures were excluded. Results: Perforations in 72 of 217,507 EGD procedures were identified (incidence, 0.033%); 124,844 EGDs included an interventional procedure and 92,663 were examination only. The incidence of perforation was similar whether an interventional procedure was performed or not (0.040% vs 0.029%; P = .181). The esophagus was injured most commonly (51%), followed by the duodenum (32%), jejunum (6%), stomach (3%), and common bile duct (3%). Overall mortality after perforation was 17% with a morbidity rate of 40%. Thirty-eight patients (49%) were initially treated nonoperatively, 7 of whom (18%) failed nonoperative management. The only factors we could determine that were associated with failure were free fluid or contrast extravasation on computed tomography (75% vs 23% [P < .005] and 33% vs 0% [P = .047], respectively). The morbidity of failures was equivalent to those who underwent initial operative management (63% vs 61%; P = .917), with mortality seeming to be greater (43% vs 21%; P = .09). Conclusion: EGD is safe in the majority of patients; however, iatrogenic perforation is associated with considerable morbidity and mortality. Nonoperative management of GI perforation can be successful if there is no evidence of contrast extravasation or free fluid on radiographic studies. If nonoperative management fails, the outcomes may be worse than those treated initially with operative repair.

AB - Background: Esophagogastroduodenoscopy (EGD) is commonly used in the diagnosis and treatment of gastrointestinal (GI) disorders. Our aim was to define the risk of perforation associated with EGD and identify patients who required operative intervention. Methods: We retrospectively reviewed 72 patients from our institution plus 5 transferred patients who sustained EGD-associated perforations from January 1996 through July 2008. Percutaneous endoscopic gastrostomy, endoscopic ultrasonography, endoscopic retrograde cholangiopancreatography, transthoracic echocardiography, and concurrent colonoscopy procedures were excluded. Results: Perforations in 72 of 217,507 EGD procedures were identified (incidence, 0.033%); 124,844 EGDs included an interventional procedure and 92,663 were examination only. The incidence of perforation was similar whether an interventional procedure was performed or not (0.040% vs 0.029%; P = .181). The esophagus was injured most commonly (51%), followed by the duodenum (32%), jejunum (6%), stomach (3%), and common bile duct (3%). Overall mortality after perforation was 17% with a morbidity rate of 40%. Thirty-eight patients (49%) were initially treated nonoperatively, 7 of whom (18%) failed nonoperative management. The only factors we could determine that were associated with failure were free fluid or contrast extravasation on computed tomography (75% vs 23% [P < .005] and 33% vs 0% [P = .047], respectively). The morbidity of failures was equivalent to those who underwent initial operative management (63% vs 61%; P = .917), with mortality seeming to be greater (43% vs 21%; P = .09). Conclusion: EGD is safe in the majority of patients; however, iatrogenic perforation is associated with considerable morbidity and mortality. Nonoperative management of GI perforation can be successful if there is no evidence of contrast extravasation or free fluid on radiographic studies. If nonoperative management fails, the outcomes may be worse than those treated initially with operative repair.

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