Aims:
Perforations are a known side effect of endoscopic procedures. A proposal for appropriate management should be available in each center and shared with radiologists and surgeons as recommended by ESGE. The objective of our study was to analyze retrospectively the results of perforation management in our center before and after 2016, in order to create a management charter based on local evidence and opinion of local experts.
Methods:
Patients were included if they underwent partial or complete perforation, during an endoscopy. We compared the management and its results in two different periods before (2008 – 2015) and after the creation of a comprehensive local database (2016 – 2018). With these results, a panel of experts was questioned to propose a consensual management charter.
Results:
105 patients with digestive perforation were included (51 between 2008 and 2015 and 54 after 2016). Perforations occurred mainly during therapeutic procedures (86.7%), with a significant increase since 2016 (96.3 versus 76.5%) (p = 0.002). Totally, 78 (74.3%) perforations were diagnosed immediately and closed during the procedure, with a clinical success of 88.5%. Closure was more effective in therapeutic (90.9%) than in diagnostic procedures (75.0%, p = 0.06). For perforations < 0.5 cm, regardless of location, endoscopic closure was effective in 97.4%, compared to 76.5% beyond 0.5 cm (p < 0.05). For perforations < 0.5 cm, systematic CT scan, antibiotics or surgical evaluation did not improve results.
Conclusions:
The detection of perforations and their closure during the procedure clearly improves the prognosis of patients with much less recourse to salvage surgery. Detection of perforations could become a quality criterion for endoscopy procedures. For incomplete (target sign) and complete perforations < 0.5 cm, endoscopic closure is almost always effective and therefore, the surgical evaluation, antibiotic therapy and CT scan could not be systematic but only in case of symptoms of leakage.
