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=Overview=
=Overview=
The [[incidence]] of [[Iatrogenesis|iatrogenic]] [[esophageal]] perforation from instrumentation has decreased, but the number of esophageal perforations from external trauma and spontaneous rupture has increased to 1 per 8,000 admissions. [[Incidence]] rates of gastric perforation varied from 1.5 to 7.8/100000 per year and from 5.2 to 40.2 regarding [[peptic ulcer]] [[bleeding]]. A perforation rate of 110 per 100,000 for [[Endoscopy|rigid endoscopy]]  and 30 per 100,000 regarding flexible endoscopy. [[Sclerotherapy]] perforation rate is 1,000 to 5,000 per 100,000. The incidence of [[Colonic Perforation|colonic perforation]] (CP) could be as low as 16 per 100,000 of all diagnostic colonoscopy procedures and may be seen in up to 5% of therapeutic colonoscopies. The [[incidence]] of CP following flexible [[sigmoidoscopy]] varies from 27 to 88 per 100,0000. Screening [[colonoscopy]] perforation rates are 1000 to 10,000 per 100,000. Anastomotic [[stricture]] dilation perforation rates are 0 to 6000 per 100,000.


===== Colonic perforation =====
==Gastrointestinal perforation epidemiology and demographics==
The incidence of Colonic perforation (CP) could be as low as 0.016% of all diagnostic colonoscopy procedures[6] and may be seen in up to 5% of therapeutic colonoscopies[7,8].  
===== Esophageal perforation<ref name="pmid8239832">{{cite journal| author=| title=Practice guidelines in cardiothoracic surgery. American Association for Thoracic Surgery, Society of Thoracic Surgeons, Southern Thoracic Surgical Association, Western Thoracic Surgical Association. | journal=Ann Thorac Surg | year= 1993 | volume= 56 | issue= 5 | pages= 1203-13 | pmid=8239832 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8239832  }}</ref> =====
* The incidence of [[Iatrogenesis|iatrogenic]] [[esophageal]] perforation from instrumentation has decreased, but the number of esophageal perforations from external trauma and spontaneous rupture has increased.
* In the period from 1950 to 1954 there was 1 perforation per 20,000 admissions.
* The incidence has now risen to 1 per 8,000 admissions.  


the incidence of CP following flexible sigmoidoscopy varies from 0.027% to 0.088%. [1,9-12]  
===== Gastric perforation<ref name="pmid19379513">{{cite journal| author=Hermansson M, Ekedahl A, Ranstam J, Zilling T| title=Decreasing incidence of peptic ulcer complications after the introduction of the proton pump inhibitors, a study of the Swedish population from 1974-2002. | journal=BMC Gastroenterol | year= 2009 | volume= 9 | issue=  | pages= 25 | pmid=19379513 | doi=10.1186/1471-230X-9-25 | pmc=2679757 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19379513  }}</ref> =====
* There is lower incidence of [[peptic ulcer]] complications during the later years. 
* Incidence rates varied from 1.5 to 7.8/100000 per year regarding perforated peptic ulcers and from 5.2 to 40.2 regarding peptic ulcer [[bleeding]]. 


Rectal perforation during colonoscopic retroflexion was reported to be around 0.01%. [13]  
===== Upper endodcopy-related GIT perforation<ref name="pmid18570335">{{cite journal| author=Bhatia NL, Collins JM, Nguyen CC, Jaroszewski DE, Vikram HR, Charles JC| title=Esophageal perforation as a complication of esophagogastroduodenoscopy. | journal=J Hosp Med | year= 2008 | volume= 3 | issue= 3 | pages= 256-62 | pmid=18570335 | doi=10.1002/jhm.289 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18570335  }}</ref> =====
* A perforation rate of 110 per 100,000 for [[Endoscopy|rigid endoscopy]].
* Diagnostic endoscopy with a flexible [[endoscope]] perforation rate is 30 per 100,000.
* [[Stricture]] dilation perforation rate is 90 to 2200 per 100,000.
* [[Sclerotherapy]] perforation rate is 1,000 to 5,000 per 100,000.
* [[Pneumatic tube|Pneumatic dilation]] for [[achalasia]] perforation rate is 2,000 to 6,000 per 100,000.
* The incidence of perforation related to endoscopy increases with procedural complexity.
* Mortality rates due to perforation are 20 percent.


===== Peptic perforation =====
===== Colonic perforation<ref name="pmid19778446">{{cite journal| author=Lohsiriwat V, Sujarittanakarn S, Akaraviputh T, Lertakyamanee N, Lohsiriwat D, Kachinthorn U| title=What are the risk factors of colonoscopic perforation? | journal=BMC Gastroenterol | year= 2009 | volume= 9 | issue=  | pages= 71 | pmid=19778446 | doi=10.1186/1471-230X-9-71 | pmc=2760570 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19778446  }}</ref> =====
There is lower incidence of peptic ulcer complications during the later years.
* The incidence of [[Colonic Perforation|colonic perforation]] (CP) could be as low as 16 per 100,000 of all diagnostic colonoscopy procedures and may be seen in up to 5% of therapeutic colonoscopies.
* The incidence of CP following flexible [[sigmoidoscopy]] varies from 27 to 88 per 100,0000.
* [[Rectal|Rectal perforation]] during [[colonoscopy]] was reported to be around 10 per 100,0000.  


Incidence rates varied from 1.5 to 7.8/100000 per year regarding perforated peptic ulcers and from 5.2 to 40.2 regarding peptic ulcer bleeding. 
===== Colonoscopy-related GIT perforation<ref name="pmid20101766">{{cite journal| author=Lohsiriwat V| title=Colonoscopic perforation: incidence, risk factors, management and outcome. | journal=World J Gastroenterol | year= 2010 | volume= 16 | issue= 4 | pages= 425-30 | pmid=20101766 | doi= | pmc=2811793 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20101766  }}</ref> =====
 
* Screening [[colonoscopy]] perforation rates are 1000 to 10,000 per 100,000.
Esophageal perforation 
* Anastomotic [[stricture]] dilation perforation rates are 0 to 6000 per 100,000.
 
* [[Crohn's disease]] stricture dilation perforation rates are 0 to 18,000 per 100,0000.
Seventeen esophageal perforations (1.7%) occurred in the course of 1011 procedures. Four perforations resulted from balloon dilatation, and 13 were secondary to bougienage. Six patients were managed surgically (35%), all of them recovering uneventfully. Eleven patients were managed conservatively, mainly because they were unfit for surgery. Survival rate in this group was 82%; only two patients died, both of whom had underlying malignant diseas
* Stent placement perforation rates are 4000 per 100,000.
 
* Colonic decompression tube placement perforation rates are 2000 per 100,000.
We recently reported a 9% incidence of bowel perforation in our
* Colonic endoscopic mucosal resection perforation rates are 0 to 5 per 100.000.
cohort of 1062 patients with biopsy-proven GI involvement with
* [[Mortality rate|Mortality rates]] from iatrogenic [[Colonic Perforation|colonic perforation]] range from 0 to 650 per 100,000.
lymphoma [1]. Among the 100 perforation events, the small
* The [[incidence]] of perforation during [[colonoscopy]] increases as the complexity of the procedure increases and is estimated at 1:1000 for therapeutic [[colonoscopy]] and 1:1400 for overall colonoscopies.
bowel was the most common site of perforation and diffuse large
* The rectosigmoid area was most commonly perforated followed by the [[cecum]], 53 percent and 24 percent, respectively.
B-cell lymphoma (DLBCL) was the most common histology. The
* Most perforations were due to blunt injury, 27 percent of perforations occurred with [[polypectomy]], and 18 percent of perforations were produced by thermal injury.
risk of perforation seems to vary by both the site of involvement
as well as the type of lymphoma. Herein, we report additional
data from the same cohort of patients regarding site-specific incidence
of perforation, stratified by lymphoma histology (Table 1).
Among the 1062 GI lymphomas in our series, the stomach was
the most frequent site of involvement (44%), followed by the
colon/rectum (25%), small bowel (24%) and duodenum (7%).
The esophagus was the least frequently involved (<1%). Overall,
DLBCL was the most frequent histology (39%) and was associated
with the highest frequency of perforations (13.2%), whereas
mucosa-associated lymphoid tissue (MALT) lymphoma, the next
most frequent histology (21%), was associated with a much lower
risk of perforation (1.8%). In general, low-grade lymphomas perforated
less frequently than their high-grade counterparts, irrespective
of the site of involvement
 
 
 
The incidence of perforation related to endoscopy increases with procedural complexity. Perforation is less common with diagnostic compared with therapeutic procedures [14]. A perforation rate of 0.11 percent for rigid endoscopy contrasts with a 0.03 percent rate for flexible endoscopy [15,16]. When iatrogenic perforation occurs, there is often significant associated pathology. As an example, in the esophagus, there may be stricture, severe esophagitis [17], or a diverticulum, and the presence of cervical osteophytes also increases the risk [16]. The area of the esophagus at most risk for instrumental perforation is Killian's triangle [18], which is the part of the pharynx formed by the inferior pharyngeal constrictor and cricopharyngeus muscle. During endoscopy, perforations are frequently recognized at the time of the procedure. At other times, the perforation remains occult for several days.
 
Upper endoscopy:
 
●Diagnostic endoscopy with a flexible endoscope: 0.03 percent
 
●Diagnostic endoscopy with a rigid endoscope: 0.11 percent
 
●Stricture dilation: 0.09 to 2.2 percent
 
●Sclerotherapy: 1 to 5 percent
 
● Pneumatic dilation for achalasia: 2 to 6 percent
 
The major complication of esophageal dilation is esophageal perforation, which is associated with a mortality rate of approximately 20 percent [2].
 
The incidence of perforation is influenced by the etiology of the stricture, the experience of the endoscopist, and the techniques and equipment used. In general, perforation rates associated with esophageal stricture dilation are low, unlike procedures such as pneumatic dilation for achalasia, where perforations are estimated to complicate three to five percent of procedures
 
The perforation rate was 0.1 percent per session in a report from 1999 that looked at 1043 dilation sessions using Eder-Puestow or Savary dilators in 153 patients (over half of whom had peptic strictures) [4].
 
Colonoscopy:
 
●Screening colonoscopy: 0.01 to 0.1 percent
 
●Anastomotic stricture dilation: 0 to 6 percent
 
●Crohn disease stricture dilation: 0 to 18 percent
 
●Stent placement: 4 percent
 
●Colonic decompression tube placement: 2 percent
 
●Colonic endoscopic mucosal resection 0 to 5 percent
 
Mortality rates from iatrogenic colonic perforation range from 0 to 0.65 percent [60].
 
The incidence of perforation during colonoscopy increases as the complexity of the procedure increases and is estimated at 1:1000 for therapeutic colonoscopy and 1:1400 for overall colonoscopies.  
 
The presence of collagenous colitis appears to predispose to perforation during colonoscopy [140].
 
the rectosigmoid area was most commonly perforated (53 percent),
 
followed by the cecum (24 percent) [141]
 
most perforations were due to blunt injury, 27 percent of perforations occurred with polypectomy, and 18 percent of perforations were produced by thermal injury. Almost 25 percent of patients presented in a delayed fashion.
 
In general, perforation rates greater than 1 in 1000 screening colonoscopies or 1 in 500 for all colonoscopies should initiate evaluation of the endoscopist's technique 
 
In the late 1970s, it was estimated that 164,000 cases of sepsis occurred in the United States (US) each year [1].
 
●One national database analysis of discharge records from hospitals in the US estimated an annual rate of more than 1,665,000 cases of sepsis between 1979 and 2000 [2].
 
a global incidence of 437 per 100,000 person-years for sepsis between the years 1995 and 2015, although this rate was not reflective of contributions from low- and middle-income countries [6].
 
between 2005 and 2014 rates of septic shock determined by clinical criteria increased from 12.8 to 18.6 per 1000 hospital admissions and mortality decreased from 55 to 51 percent [7].
 
Rates increased with age, and were approximately twice as high in men than in women.  


==References==
==References==
{{Reflist|2}}

Latest revision as of 16:58, 5 February 2018


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D[2]

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Overview

The incidence of iatrogenic esophageal perforation from instrumentation has decreased, but the number of esophageal perforations from external trauma and spontaneous rupture has increased to 1 per 8,000 admissions. Incidence rates of gastric perforation varied from 1.5 to 7.8/100000 per year and from 5.2 to 40.2 regarding peptic ulcer bleeding. A perforation rate of 110 per 100,000 for rigid endoscopy and 30 per 100,000 regarding flexible endoscopy. Sclerotherapy perforation rate is 1,000 to 5,000 per 100,000. The incidence of colonic perforation (CP) could be as low as 16 per 100,000 of all diagnostic colonoscopy procedures and may be seen in up to 5% of therapeutic colonoscopies. The incidence of CP following flexible sigmoidoscopy varies from 27 to 88 per 100,0000. Screening colonoscopy perforation rates are 1000 to 10,000 per 100,000. Anastomotic stricture dilation perforation rates are 0 to 6000 per 100,000.

Gastrointestinal perforation epidemiology and demographics

Esophageal perforation[1]
  • The incidence of iatrogenic esophageal perforation from instrumentation has decreased, but the number of esophageal perforations from external trauma and spontaneous rupture has increased.
  • In the period from 1950 to 1954 there was 1 perforation per 20,000 admissions.
  • The incidence has now risen to 1 per 8,000 admissions.
Gastric perforation[2]
  • There is lower incidence of peptic ulcer complications during the later years.
  • Incidence rates varied from 1.5 to 7.8/100000 per year regarding perforated peptic ulcers and from 5.2 to 40.2 regarding peptic ulcer bleeding.
Upper endodcopy-related GIT perforation[3]
  • A perforation rate of 110 per 100,000 for rigid endoscopy.
  • Diagnostic endoscopy with a flexible endoscope perforation rate is 30 per 100,000.
  • Stricture dilation perforation rate is 90 to 2200 per 100,000.
  • Sclerotherapy perforation rate is 1,000 to 5,000 per 100,000.
  • Pneumatic dilation for achalasia perforation rate is 2,000 to 6,000 per 100,000.
  • The incidence of perforation related to endoscopy increases with procedural complexity.
  • Mortality rates due to perforation are 20 percent.
Colonic perforation[4]
  • The incidence of colonic perforation (CP) could be as low as 16 per 100,000 of all diagnostic colonoscopy procedures and may be seen in up to 5% of therapeutic colonoscopies.
  • The incidence of CP following flexible sigmoidoscopy varies from 27 to 88 per 100,0000.
  • Rectal perforation during colonoscopy was reported to be around 10 per 100,0000.
Colonoscopy-related GIT perforation[5]
  • Screening colonoscopy perforation rates are 1000 to 10,000 per 100,000.
  • Anastomotic stricture dilation perforation rates are 0 to 6000 per 100,000.
  • Crohn's disease stricture dilation perforation rates are 0 to 18,000 per 100,0000.
  • Stent placement perforation rates are 4000 per 100,000.
  • Colonic decompression tube placement perforation rates are 2000 per 100,000.
  • Colonic endoscopic mucosal resection perforation rates are 0 to 5 per 100.000.
  • Mortality rates from iatrogenic colonic perforation range from 0 to 650 per 100,000.
  • The incidence of perforation during colonoscopy increases as the complexity of the procedure increases and is estimated at 1:1000 for therapeutic colonoscopy and 1:1400 for overall colonoscopies.
  • The rectosigmoid area was most commonly perforated followed by the cecum, 53 percent and 24 percent, respectively.
  • Most perforations were due to blunt injury, 27 percent of perforations occurred with polypectomy, and 18 percent of perforations were produced by thermal injury.

References

  1. ↑ "Practice guidelines in cardiothoracic surgery. American Association for Thoracic Surgery, Society of Thoracic Surgeons, Southern Thoracic Surgical Association, Western Thoracic Surgical Association". Ann Thorac Surg. 56 (5): 1203–13. 1993. PMID 8239832.
  2. ↑ Hermansson M, Ekedahl A, Ranstam J, Zilling T (2009). "Decreasing incidence of peptic ulcer complications after the introduction of the proton pump inhibitors, a study of the Swedish population from 1974-2002". BMC Gastroenterol. 9: 25. doi:10.1186/1471-230X-9-25. PMC 2679757. PMID 19379513.
  3. ↑ Bhatia NL, Collins JM, Nguyen CC, Jaroszewski DE, Vikram HR, Charles JC (2008). "Esophageal perforation as a complication of esophagogastroduodenoscopy". J Hosp Med. 3 (3): 256–62. doi:10.1002/jhm.289. PMID 18570335.
  4. ↑ Lohsiriwat V, Sujarittanakarn S, Akaraviputh T, Lertakyamanee N, Lohsiriwat D, Kachinthorn U (2009). "What are the risk factors of colonoscopic perforation?". BMC Gastroenterol. 9: 71. doi:10.1186/1471-230X-9-71. PMC 2760570. PMID 19778446.
  5. ↑ Lohsiriwat V (2010). "Colonoscopic perforation: incidence, risk factors, management and outcome". World J Gastroenterol. 16 (4): 425–30. PMC 2811793. PMID 20101766.
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