Endoscopy 2018; 50(04): S64-S65
DOI: 10.1055/s-0038-1637218
ESGE Days 2018 oral presentations
20.04.2018 – Best care session 2
Georg Thieme Verlag KG Stuttgart · New York

ENDOSCOPIC CLOSURE OF ACUTE IATROGENIC PERFORATIONS OF THE GASTROINTESTINAL TRACT AND PREDICTORS OF NEED FOR EARLY SURGERY: A SYSTEMATIC REVIEW AND META-ANALYSIS

A Gabr
1   Saudi-German Hospital, Gastroenterology, Cairo, Egypt
,
N Ammar
2   Ain Shams University, Public Health, Cairo, Egypt
,
M El Housini
2   Ain Shams University, Public Health, Cairo, Egypt
,
C Summerton
3   Central Manchester University Hospitals, Gastroenterology, Manchester, United Kingdom
,
M Rutter
4   North Tees and Hartlepool University Hospitals, Gastroenterology, Stockton on Tees, United Kingdom
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

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    Aims:

    Acute iatrogenic perforations are one of the recognized complications of both diagnostic and therapeutic gastrointestinal endoscopy. For decades, surgical treatment has been the standard of care, but endoscopic closure has become a more popular approach, due to feasibility and the reduction of the burden of surgery, combined with the availability of various endoscopic closure devices. We aim to assess the technical and clinical success and safety of endoscopic closure, in total, and for each endoscopic device used. Also, to identify factors predicting surgery as a first line treatment, and failure of endoscopic treatment.

    Methods:

    Medical literature (Cochrane library, EMBASE, MEDLINE) from 1966 till September 2016 was searched. A systematic review and meta-analysis were performed on studies reporting technical and clinical success of endoscopic closure of acute iatrogenic perforations, according to PRISMA guidelines.

    Results:

    764 studies were identified. 28 studies, in human, met our inclusion criteria and were analysed. A total of 474 endoscopic closures were attempted in these studies. The overall technical success rate was 93.1% (n = 451/474, 95% CI: 89.8%-96.4%), clinical success was 89.7% (n = 431/474, 95% CI: 85.5%-93.9%), and complication rate was 1.3% (n = 7/474, 95% CI: 0.3%-2.3%).

    Factors predicting failure of endoscopic treatment and need for early surgical intervention included large perforation size, leucocytosis, fever, severe abdominal pain, large amount of peritoneal free air, necrotic or soft inflammatory margins, unfavourable anatomical site, stool contamination, diffuse peritonitis and failure of endoscopic closure.

    Conclusions:

    Our study suggests that endoscopic closure is a suitable treatment option for acute iatrogenic gastrointestinal perforations. Several factors have been suggested as predictors of need for surgery as a first line treatment.


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