Skip to main content
SpringerLink
Log in

Iatrogenic Complications of Digestive Endoscopy

  • Chapter
  • First Online:
Textbook of Emergency General Surgery

  • 110 Accesses

Abstract

Background: Iatrogenic perforations are deleterious complications produced during diagnostic and therapeutic digestive endoscopy. They often require surgical treatment, which is associated with high morbidity and mortality rates.

Methods: Evidence-based analysis with systematic literature review and using available Guidelines.

Diagnosis: Early diagnosis is critical for the patient’s prognosis. The clinical and biochemical presentation during the early period could be poorly specific. Computed tomography is the imaging technique of choice to confirm the clinical suspicion of endoscopy-related perforations.

Treatment: In patients with no signs of sepsis non-operative management can be considered in selected cases of colonic or esophageal perforations. This option should be used preferentially in patients presenting non-duodenal ERCP-related perforations (Stapfer’s types II–IV). This approach requires close clinical observation and repeated imaging and biochemical tests. In cases not suitable for conservative management, or after its failure, surgery should be performed with the minimum delay.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Notes

  1. 1.

    Highlight here the most important publications related to the chapter content (i.e., Guidelines).

References

  1. Rex DK, Schoenfeld PS, Cohen J, Pike IM, Adler DG, Fennerty MB, et al. Quality indicators for colonoscopy. Am J Gastroenterol. 2015;110(1):72–90.

    Article  PubMed  Google Scholar 

  2. Rembacken B, Hassan C, Riemann JF, Chilton A, Rutter M, Dumonceau JM, et al. Quality in screening colonoscopy: position statement of the European Society of Gastrointestinal Endoscopy (ESGE). Endoscopy. 2012;44(10):957–68.

    Article  CAS  PubMed  Google Scholar 

  3. de’Angelis N, Di Saverio S, Chiara O, Sartelli M, Martinez-Perez A, Patrizi F, et al. 2017 WSES guidelines for the management of iatrogenic colonoscopy perforation. World J Emerg Surg. 2018;13:5.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Dehal A, Tessier DJ. Intraperitoneal and extraperitoneal colonic perforation following diagnostic colonoscopy. JSLS. 2014;18(1):136–41.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Committee ASoP, Ben-Menachem T, Decker GA, Early DS, Evans J, Fanelli RD, et al. Adverse events of upper GI endoscopy. Gastrointest Endosc. 2012;76(4):707–18.

    Article  Google Scholar 

  6. Cotton PB, Lehman G, Vennes J, Geenen JE, Russell RC, Meyers WC, et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc. 1991;37(3):383–93.

    Article  CAS  PubMed  Google Scholar 

  7. Andriulli A, Loperfido S, Napolitano G, Niro G, Valvano MR, Spirito F, et al. Incidence rates of post-ERCP complications: a systematic survey of prospective studies. Am J Gastroenterol. 2007;102(8):1781–8.

    Article  PubMed  Google Scholar 

  8. Heldwein W, Dollhopf M, Rosch T, Meining A, Schmidtsdorff G, Hasford J, et al. The Munich Polypectomy Study (MUPS): prospective analysis of complications and risk factors in 4000 colonic snare polypectomies. Endoscopy. 2005;37(11):1116–22.

    Article  CAS  PubMed  Google Scholar 

  9. van Halsema EE, van Hooft JE, Small AJ, Baron TH, Garcia-Cano J, Cheon JH, et al. Perforation in colorectal stenting: a meta-analysis and a search for risk factors. Gastrointest Endosc. 2014;79(6):970–82 e7; quiz 83 e2, 83 e5.

    Article  PubMed  Google Scholar 

  10. Garcia Martinez MT, Ruano Poblador A, Galan Raposo L, Gay Fernandez AM, Casal Nunez JE. Perforation after colonoscopy: our 16-year experience. Rev Esp Enferm Dig. 2007;99(10):588–92.

    CAS  PubMed  Google Scholar 

  11. Samalavicius NE, Kazanavicius D, Lunevicius R, Poskus T, Valantinas J, Stanaitis J, et al. Incidence, risk, management, and outcomes of iatrogenic full-thickness large bowel injury associated with 56,882 colonoscopies in 14 Lithuanian hospitals. Surg Endosc. 2013;27(5):1628–35.

    Article  PubMed  Google Scholar 

  12. Enns R, Eloubeidi MA, Mergener K, Jowell PS, Branch MS, Pappas TM, et al. ERCP-related perforations: risk factors and management. Endoscopy. 2002;34(4):293–8.

    Article  CAS  PubMed  Google Scholar 

  13. Stapfer M, Selby RR, Stain SC, Katkhouda N, Parekh D, Jabbour N, et al. Management of duodenal perforation after endoscopic retrograde cholangiopancreatography and sphincterotomy. Ann Surg. 2000;232(2):191–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Tsuji Y, Ohata K, Ito T, Chiba H, Ohya T, Gunji T, et al. Risk factors for bleeding after endoscopic submucosal dissection for gastric lesions. World J Gastroenterol. 2010;16(23):2913–7.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Ko CW, Dominitz JA. Complications of colonoscopy: magnitude and management. Gastrointest Endosc Clin N Am. 2010;20(4):659–71.

    Article  PubMed  Google Scholar 

  16. Gerson LB, Tokar J, Chiorean M, Lo S, Decker GA, Cave D, et al. Complications associated with double balloon enteroscopy at nine US centers. Clin Gastroenterol Hepatol. 2009;7(11):1177–82.e3.

    Article  PubMed  Google Scholar 

  17. Lee C, Im JP, Kim JW, Kim SE, Ryu DY, Cha JM, et al. Risk factors for complications and mortality of percutaneous endoscopic gastrostomy: a multicenter, retrospective study. Surg Endosc. 2013;27(10):3806–15.

    Article  PubMed  Google Scholar 

  18. Sharma VK, Nguyen CC, Crowell MD, Lieberman DA, de Garmo P, Fleischer DE. A national study of cardiopulmonary unplanned events after GI endoscopy. Gastrointest Endosc. 2007;66(1):27–34.

    Article  PubMed  Google Scholar 

  19. Nelson DB. Infectious disease complications of Gl endoscopy: Part I, endogenous infections. Gastrointest Endosc. 2003;57(4):546–56.

    Article  PubMed  Google Scholar 

  20. Iqbal CW, Cullinane DC, Schiller HJ, Sawyer MD, Zietlow SP, Farley DR. Surgical management and outcomes of 165 colonoscopic perforations from a single institution. Arch Surg. 2008;143(7):701–6; discussion 6-7.

    Article  PubMed  Google Scholar 

  21. Yang SK, Xiao L, Zhang H, Xu XX, Song PA, Liu FY, et al. Significance of serum procalcitonin as biomarker for detection of bacterial peritonitis: a systematic review and meta-analysis. BMC Infect Dis. 2014;14:452.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Iqbal CW, Chun YS, Farley DR. Colonoscopic perforations: a retrospective review. J Gastrointest Surg. 2005;9(9):1229–35: discussion 36.

    Article  PubMed  Google Scholar 

  23. Shanmuganathan K, Mirvis SE, Chiu WC, Killeen KL, Scalea TM. Triple-contrast helical CT in penetrating torso trauma: a prospective study to determine peritoneal violation and the need for laparotomy. AJR Am J Roentgenol. 2001;177(6):1247–56.

    Article  CAS  PubMed  Google Scholar 

  24. Ivatury RR, Moore FA, Biffl W, Leppeniemi A, Ansaloni L, Catena F, et al. Oesophageal injuries: position paper, WSES, 2013. World J Emerg Surg. 2014;9(1):9.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Chandrasekhara V, Khashab MA, Muthusamy VR, Acosta RD, Agrawal D, Bruining DH, et al. Adverse events associated with ERCP. Gastrointest Endosc. 2017;85(1):32–47.

    Article  PubMed  Google Scholar 

  26. Tamiya Y, Nakahara K, Kominato K, Serikawa O, Watanabe Y, Tateishi H, et al. Pneumomediastinum is a frequent but minor complication during esophageal endoscopic submucosal dissection. Endoscopy. 2010;42(1):8–14.

    Article  CAS  PubMed  Google Scholar 

  27. Genzlinger JL, McPhee MS, Fisher JK, Jacob KM, Helzberg JH. Significance of retroperitoneal air after endoscopic retrograde cholangiopancreatography with sphincterotomy. Am J Gastroenterol. 1999;94(5):1267–70.

    Article  CAS  PubMed  Google Scholar 

  28. Okamoto K, Suzuki K, Takada T, Strasberg SM, Asbun HJ, Endo I, et al. Tokyo Guidelines 2018: flowchart for the management of acute cholecystitis. J Hepato-Biliary-Pancreatic Sci. 2018;25(1):55–72.

    Article  Google Scholar 

  29. Miura F, Okamoto K, Takada T, Strasberg SM, Asbun HJ, Pitt HA, et al. Tokyo Guidelines 2018: initial management of acute biliary infection and flowchart for acute cholangitis. J Hepato-Biliary-Pancreatic Sci. 2018;25(1):31–40.

    Article  Google Scholar 

  30. Broeders E, Al-Taher M, Peeters K, Bouvy N. Verres needle desufflation as an effective treatment option for colonic perforation after colonoscopy. Surg Laparosc Endosc Percutan Tech. 2015;25(2):e61–4.

    Article  PubMed  Google Scholar 

  31. Vogel SB, Rout WR, Martin TD, Abbitt PL. Esophageal perforation in adults: aggressive, conservative treatment lowers morbidity and mortality. Ann Surg. 2005;241(6):1016–21; discussion 21-3.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Chirica M, Kelly MD, Siboni S, Aiolfi A, Riva CG, Asti E, et al. Esophageal emergencies: WSES guidelines. World J Emerg Surg. 2019;14:26.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Altorjay A, Kiss J, Voros A, Bohak A. Nonoperative management of esophageal perforations. Is it justified? Ann Surg. 1997;225(4):415–21.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Schweigert M, Sousa HS, Solymosi N, Yankulov A, Fernandez MJ, Beattie R, et al. Spotlight on esophageal perforation: A multinational study using the Pittsburgh esophageal perforation severity scoring system. J Thorac Cardiovasc Surg. 2016;151(4):1002–9.

    Article  PubMed  Google Scholar 

  35. Martinez-Perez A, de’Angelis N, Brunetti F, Le Baleur Y, Paya-Llorente C, Memeo R, et al. Laparoscopic vs. open surgery for the treatment of iatrogenic colonoscopic perforations: a systematic review and meta-analysis. World J Emerg Surg. 2017;12:8.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Teoh AY, Poon CM, Lee JF, Leong HT, Ng SS, Sung JJ, et al. Outcomes and predictors of mortality and stoma formation in surgical management of colonoscopic perforations: a multicenter review. Arch Surg. 2009;144(1):9–13.

    Article  PubMed  Google Scholar 

  37. Biancari F, D'Andrea V, Paone R, Di Marco C, Savino G, Koivukangas V, et al. Current treatment and outcome of esophageal perforations in adults: systematic review and meta-analysis of 75 studies. World J Surg. 2013;37(5):1051–9.

    Article  PubMed  Google Scholar 

  38. Paspatis GA, Arvanitakis M, Dumonceau JM, Barthet M, Saunders B, Turino SY, et al. Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement—Update 2020. Endoscopy. 2020;52(9):792–810.

    Article  PubMed  Google Scholar 

  39. Vezakis A, Fragulidis G, Polydorou A. Endoscopic retrograde cholangiopancreatography-related perforations: diagnosis and management. World J Gastrointest Endosc. 2015;7(14):1135–41.

    Article  PubMed  PubMed Central  Google Scholar 

Further Reading

  • Ben-Menachem T, Decker GA, Early DS, Evans J, Fanelli RD, Fisher DA, et al. Adverse events of upper GI endoscopy. Gastrointest Endosc. 2012;76(4):707–18.

    Article  PubMed  Google Scholar 

  • Chandrasekhara V, Khashab MA, Muthusamy VR, Acosta RD, Agrawal D, Bruining DH, et al. Adverse events associated with ERCP. Gastrointest Endosc. 2017;85(1):32–47.

    Article  PubMed  Google Scholar 

  • Chirica M, Kelly MD, Siboni S, Aiolfi A, Riva CG, Asti E, et al. Esophageal emergencies: WSES guidelines. World J Emerg Surg. 2019;14:26.

    Article  PubMed  PubMed Central  Google Scholar 

  • de’Angelis N, Di Saverio S, Chiara O, Sartelli M, Martinez-Perez A, Patrizi F, et al. WSES guidelines for the management of iatrogenic colonoscopy perforation. World J Emerg Surg. 2017;2018(13):5.

    Google Scholar 

  • Dumonceau JM, Kapral C, Aabakken L, Papanikolaou IS, Tringali A, Vanbiervliet G, et al. ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2020;52(2):127–49.

    Article  PubMed  Google Scholar 

  • Fisher DA, Maple JT, Ben-Menachem T, Cash BD, Decker GA, Early DS, et al. Complications of colonoscopy. Gastrointest Endosc. 2011;74(4):745–52.

    Article  PubMed  Google Scholar 

  • Paspatis GA, Arvanitakis M, Dumonceau JM, Barthet M, Saunders B, Turino SY, et al. Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement—Update 2020. Endoscopy. 2020;52(9):792–810.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain

    Aleix Martínez-Pérez

  2. Faculty of Health Sciences, Valencian International University (VIU), Valencia, Spain

    Aleix Martínez-Pérez

  3. Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain

    Carmen Payá-Llorente

  4. Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, Clichy, France

    Nicola de’Angelis

Authors
  1. Aleix Martínez-Pérez
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Carmen Payá-Llorente
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nicola de’Angelis
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. General, Emergency and Trauma Surgery Dept., Pisa University Hospital, Pisa, Italy

    Federico Coccolini

  2. General and Emergency Surgery Dept., Bufalini Hospital, Cesena, Italy

    Fausto Catena

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Martínez-Pérez, A., Payá-Llorente, C., de’Angelis, N. (2023). Iatrogenic Complications of Digestive Endoscopy. In: Coccolini, F., Catena, F. (eds) Textbook of Emergency General Surgery. Springer, Cham. https://doi.org/10.1007/978-3-031-22599-4_33

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-22599-4_33

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-22598-7

  • Online ISBN: 978-3-031-22599-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation