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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.


==Gastrointestinal perforation epidemiology and demographics==
===== 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> =====
===== 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.
* 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.
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* The incidence has now risen to 1 per 8,000 admissions.  
* The incidence has now risen to 1 per 8,000 admissions.  


===== Peptic 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> =====
===== 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.   
* 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]].   
* 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<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> =====
===== 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 0.11 percent for [[Endoscopy|rigid endoscopy]] contrasts with a 0.03 percent rate for flexible endoscopy.  
* A perforation rate of 110 per 100,000 for [[Endoscopy|rigid endoscopy]].  
* Diagnostic endoscopy with a flexible endoscope perforation rate is 0.03 percent.
* Diagnostic endoscopy with a flexible [[endoscope]] perforation rate is 30 per 100,000.
* Diagnostic endoscopy with a rigid endoscope perforation rate is 0.11 percent.
* [[Stricture]] dilation perforation rate is 90 to 2200 per 100,000.
* [[Stricture]] dilation perforation rate is 0.09 to 2.2 percent.
* [[Sclerotherapy]] perforation rate is 1,000 to 5,000 per 100,000.
* [[Sclerotherapy]] perforation rate is 1 to 5 percent.
* [[Pneumatic tube|Pneumatic dilation]] for [[achalasia]] perforation rate is 2,000 to 6,000 per 100,000.
* [[Pneumatic tube|Pneumatic dilation]] for [[achalasia]] perforation rate is 2 to 6 percent.
* The incidence of perforation related to endoscopy increases with procedural complexity.  
* The incidence of perforation related to endoscopy increases with procedural complexity.  
* Mortality rates due to perforation are 20 percent.
* Mortality rates due to perforation are 20 percent.


===== 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> =====
===== 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> =====
* The incidence of [[Colonic Perforation|colonic perforation]] (CP) could be as low as 0.016% of all diagnostic colonoscopy procedures and may be seen in up to 5% of therapeutic colonoscopies.  
* 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 0.027% to 0.088%.  
* 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 0.01%.  
* [[Rectal|Rectal perforation]] during [[colonoscopy]] was reported to be around 10 per 100,0000.  


===== 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> =====
===== 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 0.01 to 0.1 percent.
* Screening [[colonoscopy]] perforation rates are 1000 to 10,000 per 100,000.
* Anastomotic stricture dilation perforation rates are 0 to 6 percent.
* Anastomotic [[stricture]] dilation perforation rates are 0 to 6000 per 100,000.
* [[Crohn's disease]] stricture dilation perforation rates are 0 to 18 percent.
* [[Crohn's disease]] stricture dilation perforation rates are 0 to 18,000 per 100,0000.
* Stent placement perforation rates are 4 percent.
* Stent placement perforation rates are 4000 per 100,000.
* Colonic decompression tube placement perforation rates are 2 percent.
* Colonic decompression tube placement perforation rates are 2000 per 100,000.
* Colonic endoscopic mucosal resection perforation rates are 0 to 5 percent.
* Colonic endoscopic mucosal resection perforation rates are 0 to 5 per 100.000.
* [[Mortality rate|Mortality rates]] from iatrogenic [[Colonic Perforation|colonic perforation]] range from 0 to 0.65 percent. [60]
* [[Mortality rate|Mortality rates]] from iatrogenic [[Colonic Perforation|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 [[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. [141]
* 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.
* 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==
==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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