Gastrointestinal perforation epidemiology and demographics
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
Esophageal perforation
- The incidence of iatrogenic perforation from esophageal 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.
Peptic perforation
- 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.
- A perforation rate of 0.11 percent for rigid endoscopy contrasts with a 0.03 percent rate for flexible endoscopy. [15,16].
- 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 percen
- The incidence of perforation related to endoscopy increases with procedural complexity. [14].
- Mortality rates are 20 percent. [2]
Colonic perforation
- 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].
- the incidence of CP following flexible sigmoidoscopy varies from 0.027% to 0.088%. [1,9-12]
- Rectal perforation during colonoscopic retroflexion was reported to be around 0.01%. [13]
- 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 rectosigmoid area was most commonly perforated followed by the cecum, 53 percent and 24 percent, respectivaly. [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.