Endoscopy 2020; 52(09): 792-810
DOI: 10.1055/a-1222-3191
Position Statement

Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement – Update 2020

Gregorios A. Paspatis
1   Gastroenterology Department, Venizelion General Hospital, Heraklion, Crete-Greece
Marianna Arvanitakis
2   Gastroenterology, Hepatopancreatology, and Digestive Oncology, Erasme Hospital, Universite Libre de Bruxelles, Brussels, Belgium
Jean-Marc Dumonceau
3   Gastroenterology Service, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
Marc Barthet
4   APHM, Hôpital Nord, Marseille, France
Brian Saunders
5   St Mark's Hospital, Wolfson Unit for Endoscopy, North West London Hospitals University Trust, Harrow, London, UK
Stine Ydegaard Turino
6   Department of Surgery, Zealand University Hospital, Denmark
Angad Dhillon
5   St Mark's Hospital, Wolfson Unit for Endoscopy, North West London Hospitals University Trust, Harrow, London, UK
Maria Fragaki
1   Gastroenterology Department, Venizelion General Hospital, Heraklion, Crete-Greece
Jean-Michel Gonzalez
4   APHM, Hôpital Nord, Marseille, France
Alessandro Repici
7   Department of Gastroenterology, Digestive Endoscopy Unit, IRCCS Istituto Clinico Humanitas, Milan, Italy
Roy L.J. van Wanrooij
8   Department of Gastroenterology and Hepatology, AG&M Research Institute, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
Jeanin E. van Hooft
9   Department of Gastroenterology and Hepatology, Leiden University Medical Center, The Netherlands
› Author Affiliations

Summary of Recommendations

1 ESGE recommends that each center implements a written policy regarding the management of iatrogenic perforations, including the definition of procedures that carry a higher risk of this complication. This policy should be shared with the radiologists and surgeons at each center.

2 ESGE recommends that in the case of an endoscopically identified perforation, the endoscopist reports its size and location, with an image, and statement of the endoscopic treatment that has been applied.

3 ESGE recommends that symptoms or signs suggestive of iatrogenic perforation after an endoscopic procedure should be rapidly and carefully evaluated and documented with a computed tomography (CT) scan.

4 ESGE recommends that endoscopic closure should be considered depending on the type of the iatrogenic perforation, its size, and the endoscopist expertise available at the center. Switch to carbon dioxide (CO2) endoscopic insufflation, diversion of digestive luminal content, and decompression of tension pneumoperitoneum or pneumothorax should also be performed.

5 ESGE recommends that after endoscopic closure of an iatrogenic perforation, further management should be based on the estimated success of the endoscopic closure and on the general clinical condition of the patient. In the case of no or failed endoscopic closure of an iatrogenic perforation, and in patients whose clinical condition is deteriorating, hospitalization and surgical consultation are recommended.

Supplementary material

Publication History

Article published online:
11 August 2020

© Georg Thieme Verlag KG
Stuttgart · New York

  • References

  • 1 Paspatis GA, Dumonceau JM, Barthet M. et al. Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 2014; 46: 693-711
  • 2 Akobeng AK. Principles of evidence based medicine. Arch Dis Child 2005; 90: 837-840
  • 3 Dumonceau JM, Hassan C, Riphaus A. et al. European Society of Gastrointestinal Endoscopy (ESGE) Guideline Development Policy. Endoscopy 2012; 44: 626-629
  • 4 Martinez-Perez A, de’Angelis N, Brunetti F. et al. Laparoscopic vs. open surgery for the treatment of iatrogenic colonoscopic perforations: a systematic review and meta-analysis. World J Emerg Surg 2017; 12: 8
  • 5 Polydorou A, Vezakis A, Fragulidis G. et al. A tailored approach to the management of perforations following endoscopic retrograde cholangiopancreatography and sphincterotomy. J Gastrointest Surg 2011; 15: 2211-2217
  • 6 Kaminski MF, Thomas-Gibson S, Bugajski M. et al. Performance measures for lower gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. United European Gastroenterol J 2017; 5: 309-334
  • 7 Bisschops R, Areia M, Coron E. et al. Performance measures for upper gastrointestinal endoscopy: A European Society of Gastrointestinal Endoscopy Quality Improvement Initiative. United European Gastroenterol J 2016; 4: 629-656
  • 8 Toyonaga T, Man-i M, East JE. et al. 1,635 Endoscopic submucosal dissection cases in the esophagus, stomach, and colorectum: complication rates and long-term outcomes. Surg Endosc 2013; 27: 1000-1008
  • 9 Paspatis GA, Konstantinidis K, Tribonias G. et al. Sixty- versus thirty-seconds papillary balloon dilation after sphincterotomy for the treatment of large bile duct stones: a randomized controlled trial. Dig Liver Dis 2013; 45: 301-304
  • 10 Mangiavillano B, Caruso A, Manta R. et al. Over-the-scope clips in the treatment of gastrointestinal tract iatrogenic perforation: A multicenter retrospective study and a classification of gastrointestinal tract perforations. World J Gastrointest Surg 2016; 8: 315-320
  • 11 Jayanna M, Burgess NG, Singh R. et al. Cost analysis of endoscopic mucosal resection vs surgery for large laterally spreading colorectal lesions. Clin Gastroenterol Hepatol 2016; 14: 271-278 .e271-272
  • 12 Cotton PB, Eisen GM, Aabakken L. et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010; 71: 446-454
  • 13 Raju GS, Saito Y, Matsuda T. et al. Endoscopic management of colonoscopic perforations (with videos). Gastrointest Endosc 2011; 74: 1380-1388
  • 14 Baron TH, Wong Kee Song LM. et al. A comprehensive approach to the management of acute endoscopic perforations (with videos). Gastrointest Endosc 2012; 76: 838-859
  • 15 Jin YJ, Jeong S, Kim JH. et al. Clinical course and proposed treatment strategy for ERCP-related duodenal perforation: a multicenter analysis. Endoscopy 2013; 45: 806-812
  • 16 Sdralis EIK, Petousis S, Rashid F. et al. Epidemiology, diagnosis, and management of esophageal perforations: systematic review. Dis Esophagus 2017; 30: 1-6
  • 17 Iqbal CW, Cullinane DC, Schiller HJ. et al. Surgical management and outcomes of 165 colonoscopic perforations from a single institution. Arch Surg 2008; 143: 701-706 ; discussion 706-707
  • 18 Ignjatovic A, Saunders BP. A clinical case of delayed caecal perforation. Gut 2009; 58: 1170-; author reply 1170-1171
  • 19 Paspatis GA, Vardas E, Theodoropoulou A. et al. Complications of colonoscopy in a large public county hospital in Greece. A 10-year study. Dig Liver Dis 2008; 40: 951-957
  • 20 Carr-Locke DL. The changing management of colonoscopy-associated perforations. Digestion 2008; 78: 216-217
  • 21 McCarthy CJ, Butros SR, Dawson SL. et al. Image-guided percutaneous management of duodenal perforation following endoscopic retrograde cholangiopancreatography (ERCP): assessment of efficacy and safety. Clin Radiol 2018; 73: 319 e319–319 e315
  • 22 Kim DH, Pickhardt PJ, Taylor AJ. et al. Imaging evaluation of complications at optical colonoscopy. Curr Probl Diagn Radiol 2008; 37: 165-177
  • 23 Furukawa A, Sakoda M, Yamasaki M. et al. Gastrointestinal tract perforation: CT diagnosis of presence, site, and cause. Abdom Imaging 2005; 30: 524-534
  • 24 Zissin R, Hertz M, Osadchy A. et al. Abdominal CT findings in nontraumatic colorectal perforation. Eur J Radiol 2008; 65: 125-132
  • 25 Carrott Jr PW, Low DE. Advances in the management of esophageal perforation. Thorac Surg Clin 2011; 21: 541-555
  • 26 Tamiya Y, Nakahara K, Kominato K. et al. Pneumomediastinum is a frequent but minor complication during esophageal endoscopic submucosal dissection. Endoscopy 2010; 42: 8-14
  • 27 Raju GS, Fritscher-Ravens A, Rothstein RI. et al. Endoscopic closure of colon perforation compared to surgery in a porcine model: a randomized controlled trial (with videos). Gastrointest Endosc 2008; 68: 324-332
  • 28 Fritscher-Ravens A, Hampe J, Grange P. et al. Clip closure versus endoscopic suturing versus thoracoscopic repair of an iatrogenic esophageal perforation: a randomized, comparative, long-term survival study in a porcine model (with videos). Gastrointest Endosc 2010; 72: 1020-1026
  • 29 Schmidt A, Fuchs KH, Caca K. et al. The endoscopic treatment of iatrogenic gastrointestinal perforation. Dtsch Arztebl Int 2016; 113: 121-128
  • 30 Stavropoulos SN, Modayil R, Friedel D. Closing perforations and postperforation management in endoscopy: esophagus and stomach. Gastrointest Endosc Clin N Am 2015; 25: 29-45
  • 31 Daram SR, Tang SJ, Wu R. et al. Benchtop testing and comparisons among three types of through-the-scope endoscopic clipping devices. Surg Endosc 2013; 27: 1521-1529
  • 32 Lazar G, Paszt A, Man E. Role of endoscopic clipping in the treatment of oesophageal perforations. World J Gastrointest Endosc 2016; 8: 13-22
  • 33 Haito-Chavez Y, Law JK, Kratt T. et al. International multicenter experience with an over-the-scope clipping device for endoscopic management of GI defects (with video). Gastrointest Endosc 2014; 80: 610-622
  • 34 Belfiori V, Antonini F, Deminicis S. et al. Successful closure of anastomotic dehiscence after colon–rectal cancer resection using the Apollo overstitch suturing system. Endoscopy 2017; 49: 823-824
  • 35 Modayil R, Friedel D, Stavropoulos SN. Endoscopic suture repair of a large mucosal perforation during peroral endoscopic myotomy for treatment of achalasia. Gastrointest Endosc 2014; 80: 1169-1170
  • 36 Iabichino G, Eusebi LH, Palamara MA. et al. Performance of the over-the-scope clip system in the endoscopic closure of iatrogenic gastrointestinal perforations and post-surgical leaks and fistulas. Minerva Gastroenterol Dietol 2018; 64: 75-83
  • 37 Kobara H, Mori H, Nishiyama N. et al. Over-the-scope clip system: A review of 1517 cases over 9 years. J Gastroenterol Hepatol 2019; 34: 22-30
  • 38 Voermans RP, Le Moine O, von Renteln D. et al. Efficacy of endoscopic closure of acute perforations of the gastrointestinal tract. Clin Gastroenterol Hepatol 2012; 10: 603-608
  • 39 Lin BW, Thanassi W. Tension pneumoperitoneum. J Emerg Med 2010; 38: 57-59
  • 40 Lo SK, Fujii-Lau LL, Enestvedt BK. et al. The use of carbon dioxide in gastrointestinal endoscopy. Gastrointest Endosc 2016; 83: 857-865
  • 41 Kim SY, Chung JW, Kim JH. et al. Carbon dioxide insufflation during endoscopic resection of large colorectal polyps can reduce post-procedure abdominal pain: A prospective, double-blind, randomized controlled trial. United European Gastroenterol J 2018; 6: 1089-1098
  • 42 Baniya R, Upadhaya S, Khan J. et al. Carbon dioxide versus air insufflation in gastric endoscopic submucosal dissection: a systematic review and meta-analysis of randomized controlled trials. Clin Endosc 2017; 50: 464-472
  • 43 Li X, Dong H, Zhang Y. et al. CO2 insufflation versus air insufflation for endoscopic submucosal dissection: A meta-analysis of randomized controlled trials. PLoS One 2017; 12: e0177909 DOI: 10.1371/journal.pone.0177909.
  • 44 Swan MP, Bourke MJ, Moss A. et al. The target sign: an endoscopic marker for the resection of the muscularis propria and potential perforation during colonic endoscopic mucosal resection. Gastrointest Endosc 2011; 73: 79-85
  • 45 Di Leo M, Maselli R, Ferrara EC. et al. Endoscopic management of benign esophageal ruptures and leaks. Curr Treat Options Gastroenterol 2017; 15: 268-284
  • 46 Weimann A, Braga M, Carli F. et al. ESPEN guideline: Clinical nutrition in surgery. Clin Nutr 2017; 36: 623-650
  • 47 Knudson K, Raeburn CD, McIntyre Jr. RC. et al. Management of duodenal and pancreaticobiliary perforations associated with periampullary endoscopic procedures. Am J Surg 2008; 196: 975-981 ; discussion 981-972
  • 48 Alfieri S, Rosa F, Cina C. et al. Management of duodeno-pancreato-biliary perforations after ERCP: outcomes from an Italian tertiary referral center. Surg Endosc 2013; 27: 2005-2012
  • 49 Enns R, Branch MS. Management of esophageal perforation after therapeutic upper gastrointestinal endoscopy. Gastrointest Endosc 1998; 47: 318-320
  • 50 Pilgrim CH, Nottle PD. Laparoscopic repair of iatrogenic colonic perforation. Surg Laparosc Endosc Percutan Tech 2007; 17: 215-217
  • 51 Soreide JA, Konradsson A, Sandvik OM. et al. Esophageal perforation: clinical patterns and outcomes from a patient cohort of Western Norway. Dig Surg 2012; 29: 494-502
  • 52 Ben-Menachem T, Decker GA, Early DS. et al. Adverse events of upper GI endoscopy. Gastrointest Endosc 2012; 76: 707-718
  • 53 Goyal A, Chatterjee K, Yadlapati S. et al. Health-care utilization and complications of endoscopic esophageal dilation in a national population. Clin Endosc 2017; 50: 366-371
  • 54 Hernandez LV, Jacobson JW, Harris MS. Comparison among the perforation rates of Maloney, balloon, and Savary dilation of esophageal strictures. Gastrointest Endosc 2000; 51: 460-462
  • 55 Josino IR, Madruga-Neto AC, Ribeiro IB. et al. Endoscopic dilation with bougies versus balloon dilation in esophageal benign strictures: systematic review and meta-analysis. Gastroenterol Res Pract 2018; 2018: 5874870
  • 56 Grooteman KV, Wong Kee Song LM. et al. Non-adherence to the rule of 3 does not increase the risk of adverse events in esophageal dilation. Gastrointest Endosc 2017; 85: 332-337 .e331
  • 57 Campos GM, Vittinghoff E, Rabl C. et al. Endoscopic and surgical treatments for achalasia: a systematic review and meta-analysis. Ann Surg 2009; 249: 45-57
  • 58 Ponds FA, Fockens P, Lei A. et al. Effect of peroral endoscopic myotomy vs pneumatic dilation on symptom severity and treatment outcomes among treatment-naive patients with achalasia: a randomized clinical trial. JAMA 2019; 322: 134-144
  • 59 Jain D, Sharma A, Shah M. et al. Efficacy and safety of flexible endoscopic management of Zenker’s diverticulum. J Clin Gastroenterol 2018; 52: 369-385
  • 60 Komeda Y, Bruno M, Koch A. EMR is not inferior to ESD for early Barrett's and EGJ neoplasia: An extensive review on outcome, recurrence and complication rates. Endosc Int Open 2014; 2: E58-64
  • 61 Tomizawa Y, Konda VJA, Coronel E. et al. Efficacy, durability, and safety of complete endoscopic mucosal resection of Barrett esophagus: a systematic review and meta-analysis. J Clin Gastroenterol 2018; 52: 210-216
  • 62 Terheggen G, Horn EM, Vieth M. et al. A randomised trial of endoscopic submucosal dissection versus endoscopic mucosal resection for early Barrett's neoplasia. Gut 2017; 66: 783-793
  • 63 Shimizu Y, Takahashi M, Yoshida T. et al. Endoscopic resection (endoscopic mucosal resection/ endoscopic submucosal dissection) for superficial esophageal squamous cell carcinoma: current status of various techniques. Dig Endosc 2013; 25 (Suppl. 01) 13-19
  • 64 Sato H, Inoue H, Ikeda H. et al. Clinical experience of esophageal perforation occurring with endoscopic submucosal dissection. Dis Esophagus 2014; 27: 617-622
  • 65 Noguchi M, Yano T, Kato T. et al. Risk factors for intraoperative perforation during endoscopic submucosal dissection of superficial esophageal squamous cell carcinoma. World J Gastroenterol 2017; 23: 478-485
  • 66 Lv XH, Wang CH, Xie Y. Efficacy and safety of submucosal tunneling endoscopic resection for upper gastrointestinal submucosal tumors: a systematic review and meta-analysis. Surg Endosc 2017; 31: 49-63
  • 67 Patel K, Abbassi-Ghadi N, Markar S. et al. Peroral endoscopic myotomy for the treatment of esophageal achalasia: systematic review and pooled analysis. Dis Esophagus 2016; 29: 807-819
  • 68 Werner YB, von Renteln D, Noder T. et al. et al. Early adverse events of per-oral endoscopic myotomy. Gastrointest Endosc 2017; 85: 708-718 .e702
  • 69 Birk M, Bauerfeind P, Deprez PH. et al. Removal of foreign bodies in the upper gastrointestinal tract in adults: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2016; 48: 489-496
  • 70 Hong KH, Kim YJ, Kim JH. et al. Risk factors for complications associated with upper gastrointestinal foreign bodies. World J Gastroenterol 2015; 21: 8125-8131
  • 71 Kowalczyk L, Forsmark CE, Ben-David K. et al. Algorithm for the management of endoscopic perforations: a quality improvement project. Am J Gastroenterol 2011; 106: 1022-1027
  • 72 Maeda Y, Hirasawa D, Fujita N. et al. Mediastinal emphysema after esophageal endoscopic submucosal dissection: its prevalence and clinical significance. Dig Endosc 2011; 23: 221-226
  • 73 Maeda Y, Hirasawa D, Fujita N. et al. Carbon dioxide insufflation in esophageal endoscopic submucosal dissection reduces mediastinal emphysema: A randomized, double-blind, controlled trial. World J Gastroenterol 2016; 22: 7373-7382
  • 74 Sancheti MS, Fernandez FG. Surgical management of esophageal perforation. Oper Tech Thoracic Cardiovasc Surg 2015; 20: 234-250
  • 75 Kuppusamy MK, Hubka M, Felisky CD. et al. Evolving management strategies in esophageal perforation: surgeons using nonoperative techniques to improve outcomes. J Am Coll Surg 2011; 213: 164-171
  • 76 Hagel AF, Naegel A, Lindner AS. et al. Over-the-scope clip application yields a high rate of closure in gastrointestinal perforations and may reduce emergency surgery. J Gastrointest Surg 2012; 16: 2132-2138
  • 77 Seven G, Irani S, Ross AS. et al. Partially versus fully covered self-expanding metal stents for benign and malignant esophageal conditions: a single center experience. Surg Endosc 2013; 27: 2185-2192
  • 78 Thornblade LW, Cheng AM, Wood DE. et al. A nationwide rise in the use of stents for benign esophageal perforation. Ann Thorac Surg 2017; 104: 227-233
  • 79 van Boeckel PG, Sijbring A, Vleggaar FP. et al. Systematic review: temporary stent placement for benign rupture or anastomotic leak of the oesophagus. Aliment Pharmacol Ther 2011; 33: 1292-1301
  • 80 Dasari BV, Neely D, Kennedy A. et al. The role of esophageal stents in the management of esophageal anastomotic leaks and benign esophageal perforations. Ann Surg 2014; 259: 852-860
  • 81 El II H, Imperiale TF, Rex DK. et al. Treatment of esophageal leaks, fistulae, and perforations with temporary stents: evaluation of efficacy, adverse events, and factors associated with successful outcomes. Gastrointest Endosc 2014; 79: 589-598
  • 82 Gubler C, Bauerfeind P. Self-expandable stents for benign esophageal leakages and perforations: long-term single-center experience. Scand J Gastroenterol 2014; 49: 23-29
  • 83 Persson S, Elbe P, Rouvelas I. et al. Predictors for failure of stent treatment for benign esophageal perforations – a single center 10-year experience. World J Gastroenterol 2014; 20: 10613-10619
  • 84 van den Berg MW, Kerbert AC, van Soest EJ. et al. Safety and efficacy of a fully covered large-diameter self-expanding metal stent for the treatment of upper gastrointestinal perforations, anastomotic leaks, and fistula. Dis Esophagus 2016; 29: 572-579
  • 85 Freeman RK, Ascioti AJ, Dake M. et al. An assessment of the optimal time for removal of esophageal stents used in the treatment of an esophageal anastomotic leak or perforation. Ann Thorac Surg 2015; 100: 422-428
  • 86 Navaneethan U, Lourdusamy V, Duvuru S. et al. Timing of esophageal stent placement and outcomes in patients with esophageal perforation: a single-center experience. Surg Endosc 2015; 29: 700-707
  • 87 van Halsema EE, Kappelle WFW, Weusten B. et al. Stent placement for benign esophageal leaks, perforations, and fistulae: a clinical prediction rule for successful leakage control. Endoscopy 2018; 50: 98-108
  • 88 Huh CW, Kim JS, Choi HH. et al. Treatment of benign perforations and leaks of the esophagus: factors associated with success after stent placement. Surg Endosc 2018; 32: 3646-3651
  • 89 Monkemuller K, Martinez-Alcala A, Schmidt AR. et al. The use of the over the scope clips beyond its standard use: a pictorial description. Gastrointest Endosc Clin N Am 2020; 30: 41-74
  • 90 Lindenmann J, Maier A, Fink-Neuboeck N. et al. Fatal aortic hemorrhage after over-the-scope clipping and subsequent esophageal stenting for sealing of iatrogenic esophageal perforation. Endoscopy 2015; 47 (Suppl. 01) E280-E281
  • 91 Newton NJ, Sharrock A, Rickard R. et al. Systematic review of the use of endo-luminal topical negative pressure in oesophageal leaks and perforations. Dis Esophagus 2017; 30: 1-5
  • 92 Rausa E, Asti E, Aiolfi A. et al. Comparison of endoscopic vacuum therapy versus endoscopic stenting for esophageal leaks: systematic review and meta-analysis. Dis Esophagus 2018; 31 DOI: 10.1093/dote/doy060.
  • 93 Leers JM, Vivaldi C, Schafer H. et al. Endoscopic therapy for esophageal perforation or anastomotic leak with a self-expandable metallic stent. Surg Endosc 2009; 23: 2258-2262
  • 94 Persson S, Rouvelas I, Irino T. et al. Outcomes following the main treatment options in patients with a leaking esophagus: a systematic literature review. Dis Esophagus 2017; 30: 1-10
  • 95 Zimmermann M, Hoffmann M, Jungbluth T. et al. Predictors of morbidity and mortality in esophageal perforation: retrospective study of 80 patients. Scand J Surg 2017; 106: 126-132
  • 96 Schweigert M, Sousa HS, Solymosi N. et al. Spotlight on esophageal perforation: A multinational study using the Pittsburgh esophageal perforation severity scoring system. J Thorac Cardiovasc Surg 2016; 151: 1002-1009
  • 97 Ben-David K, Behrns K, Hochwald S. et al. Esophageal perforation management using a multidisciplinary minimally invasive treatment algorithm. J Am Coll Surg 2014; 218: 768-774
  • 98 Biancari F, Saarnio J, Mennander A. et al. Outcome of patients with esophageal perforations: a multicenter study. World J Surg 2014; 38: 902-909
  • 99 Biancari F, Gudbjartsson T, Mennander A. et al. Treatment of esophageal perforation in octogenarians: a multicenter study. Dis Esophagus 2014; 27: 715-718
  • 100 Kuppusamy MK, Felisky C, Kozarek RA. et al. Impact of endoscopic assessment and treatment on operative and non-operative management of acute oesophageal perforation. Br J Surg 2011; 98: 818-824
  • 101 Markar SR, Mackenzie H, Wiggins T. et al. Management and outcomes of esophageal perforation: a national study of 2,564 patients in England. Am J Gastroenterol 2015; 110: 1559-1566
  • 102 Ukleja A, Afonso BB, Pimentel R. et al. Outcome of endoscopic balloon dilation of strictures after laparoscopic gastric bypass. Surg Endosc 2008; 22: 1746-1750
  • 103 Yoo JH, Shin SJ, Lee KM. et al. Risk factors for perforations associated with endoscopic submucosal dissection in gastric lesions: emphasis on perforation type. Surg Endosc 2012; 26: 2456-2464
  • 104 Imagawa A, Okada H, Kawahara Y. et al. Endoscopic submucosal dissection for early gastric cancer: results and degrees of technical difficulty as well as success. Endoscopy 2006; 38: 987-990
  • 105 Chung IK, Lee JH, Lee SH. et al. Therapeutic outcomes in 1000 cases of endoscopic submucosal dissection for early gastric neoplasms: Korean ESD Study Group multicenter study. Gastrointest Endosc 2009; 69: 1228-1235
  • 106 Toyokawa T, Inaba T, Omote S. et al. Risk factors for perforation and delayed bleeding associated with endoscopic submucosal dissection for early gastric neoplasms: analysis of 1123 lesions. J Gastroenterol Hepatol 2012; 27: 907-912
  • 107 Fujishiro M, Yahagi N, Kakushima N. et al. Successful nonsurgical management of perforation complicating endoscopic submucosal dissection of gastrointestinal epithelial neoplasms. Endoscopy 2006; 38: 1001-1006
  • 108 Binmoeller KF, Grimm H, Soehendra N. Endoscopic closure of a perforation using metallic clips after snare excision of a gastric leiomyoma. Gastrointest Endosc 1993; 39: 172-174
  • 109 Albuquerque W, Arantes V. Large gastric perforation after endoscopic mucosal resection treated by application of metallic clips (video). Endoscopy 2004; 36: 752-753
  • 110 Katsinelos P, Beltsis A, Paroutoglou G. et al. Endoclipping for gastric perforation after endoscopic polypectomy: an alternative treatment to avoid surgery. Surg Laparosc Endosc Percutan Tech 2004; 14: 279-281
  • 111 De Caro G, Pagano N, Malesci A. et al. Endoclipping for gastric perforation secondary to second session of EMRC in locally residual early gastric cancer: a case report. Dig Liver Dis 2009; 41: e32-e34
  • 112 Kim HS, Lee DK, Jeong YS. et al. Successful endoscopic management of a perforated gastric dysplastic lesion after endoscopic mucosal resection. Gastrointest Endosc 2000; 51: 613-615
  • 113 Minami S, Gotoda T, Ono H. et al. Complete endoscopic closure of gastric perforation induced by endoscopic resection of early gastric cancer using endoclips can prevent surgery (with video). Gastrointest Endosc 2006; 63: 596-601
  • 114 Tsunada S, Ogata S, Ohyama T. et al. Endoscopic closure of perforations caused by EMR in the stomach by application of metallic clips. Gastrointest Endosc 2003; 57: 948-951
  • 115 Kirschniak A, Subotova N, Zieker D. et al. The over-the-scope clip (OTSC) for the treatment of gastrointestinal bleeding, perforations, and fistulas. Surg Endosc 2011; 25: 2901-2905
  • 116 Baron TH, Song LM, Ross A. et al. Use of an over-the-scope clipping device: multicenter retrospective results of the first U.S. experience (with videos). Gastrointest Endosc 2012; 76: 202-208
  • 117 Nishiyama N, Mori H, Kobara H. et al. Efficacy and safety of over-the-scope clip: including complications after endoscopic submucosal dissection. World J Gastroenterol 2013; 19: 2752-2760
  • 118 Han JH, Lee TH, Jung Y. et al. Rescue endoscopic band ligation of iatrogenic gastric perforations following failed endoclip closure. World J Gastroenterol 2013; 19: 955-959
  • 119 Iwashita T, Lee JG, Nakai Y. et al. Successful management of perforation during cystogastrostomy with an esophageal fully covered metallic stent placement. Gastrointest Endosc 2012; 76: 214-215
  • 120 Kim GJ, Park SM, Kim JS. et al. Risk factors for additional surgery after iatrogenic perforations due to endoscopic submucosal dissection. Gastroenterol Res Pract 2017; 2017: 6353456
  • 121 Merchea A, Cullinane DC, Sawyer MD. et al. Esophagogastroduodenoscopy-associated gastrointestinal perforations: a single-center experience. Surgery 2010; 148: 876-880; discussion 881-872
  • 122 Mangiavillano B, Viaggi P, Masci E. Endoscopic closure of acute iatrogenic perforations during diagnostic and therapeutic endoscopy in the gastrointestinal tract using metallic clips: a literature review. J Dig Dis 2010; 11: 12-18
  • 123 Surace M, Mercky P, Demarquay JF. et al. Endoscopic management of GI fistulae with the over-the-scope clip system (with video). Gastrointest Endosc 2011; 74: 1416-1419
  • 124 von Renteln D, Denzer UW, Schachschal G. et al. Endoscopic closure of GI fistulae by using an over-the-scope clip (with videos). Gastrointest Endosc 2010; 72: 1289-1296
  • 125 Parodi A, Repici A, Pedroni A. et al. Endoscopic management of GI perforations with a new over-the-scope clip device (with videos). Gastrointest Endosc 2010; 72: 881-886
  • 126 Manta R, Manno M, Bertani H. et al. Endoscopic treatment of gastrointestinal fistulas using an over-the-scope clip (OTSC) device: case series from a tertiary referral center. Endoscopy 2011; 43: 545-548
  • 127 Honegger C, Valli PV, Wiegand N. et al. Establishment of over-the-scope-clips (OTSC(R)) in daily endoscopic routine. United European Gastroenterol J 2017; 5: 247-254
  • 128 Martinek J, Ryska O, Tuckova I. et al. Comparing over-the-scope clip versus endoloop and clips (KING closure) for access site closure: a randomized experimental study. Surg Endosc 2013; 27: 1203-1210
  • 129 Shi Q, Chen T, Zhong YS. et al. Complete closure of large gastric defects after endoscopic full-thickness resection, using endoloop and metallic clip interrupted suture. Endoscopy 2013; 45: 329-334
  • 130 Stapfer M, Selby RR, Stain SC. et al. Management of duodenal perforation after endoscopic retrograde cholangiopancreatography and sphincterotomy. Ann Surg 2000; 232: 191-198
  • 131 Andriulli A, Loperfido S, Napolitano G. et al. Incidence rates of post-ERCP complications: a systematic survey of prospective studies. Am J Gastroenterol 2007; 102: 1781-1788
  • 132 Cirocchi R, Kelly MD, Griffiths EA. et al. A systematic review of the management and outcome of ERCP related duodenal perforations using a standardized classification system. Surgeon 2017; 15: 379-387
  • 133 Enns R, Eloubeidi MA, Mergener K. et al. ERCP-related perforations: risk factors and management. Endoscopy 2002; 34: 293-298
  • 134 Weiser R, Pencovich N, Mlynarsky L. et al. Management of endoscopic retrograde cholangiopancreatography-related perforations: Experience of a tertiary center. Surgery 2017; 161: 920-929
  • 135 Shi D, Yang JF, Liu YP. Endoscopic treatment of endoscopic retrograde cholangiopancreatography-related duodenal perforations. J Laparoendosc Adv Surg Tech A 2019; 29: 385-391
  • 136 Odemis B, Oztas E, Kuzu UB. et al. Can a fully covered self-expandable metallic stent be used temporarily for the management of duodenal retroperitoneal perforation during ercp as a part of conservative therapy?. Surg Laparosc Endosc Percutan Tech 2016; 26: e9-e17
  • 137 Jeon HJ, Han JH, Park S. et al. Endoscopic sphincterotomy-related perforation in the common bile duct successfully treated by placement of a covered metal stent. Endoscopy 2011; 43 (Suppl. 02) E295-E296
  • 138 Lee SM, Cho KB. Value of temporary stents for the management of perivaterian perforation during endoscopic retrograde cholangiopancreatography. World J Clin Cases 2014; 2: 689-697
  • 139 Park WY, Cho KB, Kim ES. et al. A case of ampullary perforation treated with a temporally covered metal stent. Clin Endosc 2012; 45: 177-180
  • 140 Vezakis A, Fragulidis G, Nastos C. et al. Closure of a persistent sphincterotomy-related duodenal perforation by placement of a covered self-expandable metallic biliary stent. World J Gastroenterol 2011; 17: 4539-4541
  • 141 Theopistos V, Theocharis G, Konstantakis C. et al. Non-operative management of type 2 ERCP-related retroperitoneal duodenal perforations: a 9-year experience from a single center. Gastroenterology Res 2018; 11: 207-212
  • 142 Shami VM, Talreja JP, Mahajan A. et al. EUS-guided drainage of bilomas: a new alternative?. Gastrointest Endosc 2008; 67: 136-140
  • 143 Vezakis A, Fragulidis G, Polydorou A. Endoscopic retrograde cholangiopancreatography-related perforations: Diagnosis and management. World J Gastrointest Endosc 2015; 7: 1135-1141
  • 144 Wu HM, Dixon E, May GR. et al. Management of perforation after endoscopic retrograde cholangiopancreatography (ERCP): a population-based review. HPB (Oxford) 2006; 8: 393-399
  • 145 Fatima J, Baron TH, Topazian MD. et al. Pancreaticobiliary and duodenal perforations after periampullary endoscopic procedures: diagnosis and management. Arch Surg 2007; 142: 448-454 ; discussion 454-455
  • 146 Lee TH, Bang BW, Jeong JI. et al. Primary endoscopic approximation suture under cap-assisted endoscopy of an ERCP-induced duodenal perforation. World J Gastroenterol 2010; 16: 2305-2310
  • 147 Aranez JL, Miller J, Hughes M. et al. A novel, duodenoscope-friendly endoscopic clip for treating massive upper-GI bleeding secondary to a Dieulafoy lesion. VideoGIE 2018; 3: 205-206
  • 148 Samarasena JB, Nakai Y, Park DH. et al. Endoscopic closure of an iatrogenic duodenal perforation: a novel technique using endoclips, endoloop, and fibrin glue. Endoscopy 2012; 44 (Suppl. 02) E424-E425
  • 149 Nakagawa Y, Nagai T, Soma W. et al. Endoscopic closure of a large ERCP-related lateral duodenal perforation by using endoloops and endoclips. Gastrointest Endosc 2010; 72: 216-217
  • 150 Arvanitakis M, Dumonceau JM, Albert J. et al. Endoscopic management of acute necrotizing pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) evidence-based multidisciplinary guidelines. Endoscopy 2018; 50: 524-546
  • 151 Kayhan B, Akdogan M, Sahin B. ERCP subsequent to retroperitoneal perforation caused by endoscopic sphincterotomy. Gastrointest Endosc 2004; 60: 833-835
  • 152 Srivastava S, Sharma BC, Puri AS. et al. Impact of completion of primary biliary procedure on outcome of endoscopic retrograde cholangiopancreatographic related perforation. Endosc Int Open 2017; 5: E706-E709
  • 153 Ercan M, Bostanci EB, Dalgic T. et al. Surgical outcome of patients with perforation after endoscopic retrograde cholangiopancreatography. J Laparoendosc Adv Surg Tech A 2012; 22: 371-377
  • 154 Machado NO. Management of duodenal perforation post-endoscopic retrograde cholangiopancreatography. When and whom to operate and what factors determine the outcome? A review article. JOP 2012; 13: 18-25
  • 155 Preetha M, Chung YF, Chan WH. et al. Surgical management of endoscopic retrograde cholangiopancreatography-related perforations. ANZ J Surg 2003; 73: 1011-1014
  • 156 Sarli L, Porrini C, Costi R. et al. Operative treatment of periampullary retroperitoneal perforation complicating endoscopic sphincterotomy. Surgery 2007; 142: 26-32
  • 157 Avgerinos DV, Llaguna OH, Lo AY. et al. Management of endoscopic retrograde cholangiopancreatography: related duodenal perforations. Surg Endosc 2009; 23: 833-838
  • 158 Kim BS, Kim IG, Ryu BY. et al. Management of endoscopic retrograde cholangiopancreatography-related perforations. J Korean Surg Soc 2011; 81: 195-204
  • 159 Miller R, Zbar A, Klein Y. et al. Perforations following endoscopic retrograde cholangiopancreatography: a single institution experience and surgical recommendations. Am J Surg 2013; 206: 180-186
  • 160 Kim J, Lee SH, Paik WH. et al. Clinical outcomes of patients who experienced perforation associated with endoscopic retrograde cholangiopancreatography. Surg Endosc 2012; 26: 3293-3300
  • 161 Cotton PB, Garrow DA, Gallagher J. et al. Risk factors for complications after ERCP: a multivariate analysis of 11,497 procedures over 12 years. Gastrointest Endosc 2009; 70: 80-88
  • 162 Park TY, Kang JS, Song TJ. et al. Outcomes of ERCP in Billroth II gastrectomy patients. Gastrointest Endosc 2016; 83: 1193-1201
  • 163 Takano S, Fukasawa M, Shindo H. et al. Risk factors for perforation during endoscopic retrograde cholangiopancreatography in post-reconstruction intestinal tract. World J Clin Cases 2019; 7: 10-18
  • 164 Watanabe D, Hayashi H, Kataoka Y. et al. Efficacy and safety of endoscopic submucosal dissection for non-ampullary duodenal polyps: A systematic review and meta-analysis. Dig Liver Dis 2019; 51: 774-781
  • 165 Pimentel-Nunes P, Dinis-Ribeiro M, Ponchon T. et al. Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2015; 47: 829-854
  • 166 Perez-Cuadrado-Robles E, Queneherve L, Margos W. et al. Comparative analysis of ESD versus EMR in a large European series of non-ampullary superficial duodenal tumors. Endosc Int Open 2018; 6: E1008-E1014
  • 167 Esaki M, Suzuki S, Ikehara H. et al. Endoscopic diagnosis and treatment of superficial non-ampullary duodenal tumors. World J Gastrointest Endosc 2018; 10: 156-164
  • 168 Conio M, De Ceglie A, Filiberti R. et al. Cap-assisted EMR of large, sporadic, nonampullary duodenal polyps. Gastrointest Endosc 2012; 76: 1160-1169
  • 169 Kakushima N, Ono H, Takao T. et al. Method and timing of resection of superficial non-ampullary duodenal epithelial tumors. Dig Endosc 2014; 26 (Suppl. 02) 35-40
  • 170 de Moura EGH, Orso IRB, Aurelio EF. et al. Factors associated with complications or failure of endoscopic balloon dilation of anastomotic stricture secondary to Roux-en-Y gastric bypass surgery. Surg Obes Relat Dis 2016; 12: 582-586
  • 171 Almby K, Edholm D. Anastomotic strictures after Roux-en-Y gastric bypass: a cohort study from the Scandinavian Obesity Surgery Registry. Obes Surg 2019; 29: 172-177
  • 172 Goitein D, Papasavas PK, Gagne D. et al. Gastrojejunal strictures following laparoscopic Roux-en-Y gastric bypass for morbid obesity. Surg Endosc 2005; 19: 628-632
  • 173 Mathew A, Veliuona MA, DePalma FJ. et al. Gastrojejunal stricture after gastric bypass and efficacy of endoscopic intervention. Dig Dis Sci 2009; 54: 1971-1978
  • 174 Carrodeguas L, Szomstein S, Zundel N. et al. Gastrojejunal anastomotic strictures following laparoscopic Roux-en-Y gastric bypass surgery: analysis of 1291 patients. Surg Obes Relat Dis 2006; 2: 92-97
  • 175 Moschler O, May A, Muller MK. et al. Complications in and performance of double-balloon enteroscopy (DBE): results from a large prospective DBE database in Germany. Endoscopy 2011; 43: 484-489
  • 176 Gerson LB, Tokar J, Chiorean M. et al. Complications associated with double balloon enteroscopy at nine US centers. Clin Gastroenterol Hepatol 2009; 7: 1177-1182, 1182.e1171-1173
  • 177 Odagiri H, Matsui H, Fushimi K. et al. Factors associated with perforation related to diagnostic balloon-assisted enteroscopy: analysis of a national inpatient database in Japan. Endoscopy 2015; 47: 143-146
  • 178 Aktas H, de Ridder L, Haringsma J. et al. Complications of single-balloon enteroscopy: a prospective evaluation of 166 procedures. Endoscopy 2010; 42: 365-368
  • 179 Tominaga K, Iida T, Nakamura Y. et al. Small intestinal perforation of endoscopically unrecognized lesions during peroral single-balloon enteroscopy. Endoscopy 2008; 40 (Suppl. 02) E213-214
  • 180 Akerman PA, Cantero D. Severe complications of spiral enteroscopy in the first 1750 patients. Gastrointest Endosc 2009; 69 AB127. DOI: 10.1016/j.gie.2009.03.152.
  • 181 Welch AR, Moyer MT, Dye CE. et al. A single-center experience with spiral enteroscopy: a note of caution. Gastrointest Endosc 2012; 75: 1125-1126
  • 182 Li XB, Gu LY, Song Y. et al. Small-bowel perforation in a patient with Roux-en-Y anatomy for Peutz–Jeghers polyps after spiral enteroscopic investigation. Endoscopy 2011; 43 (Suppl. 02) E85
  • 183 Palmer JS, Marenah K, El MF. et al. Small bowel perforation following capsule endoscopy: a case report. Ann R Coll Surg Engl 2011; 93: e69-e70
  • 184 Um S, Poblete H, Zavotsky J. Small bowel perforation caused by an impacted endocapsule. Endoscopy 2008; 40 (Suppl. 02) E122-E123
  • 185 Yitzhak A, Bayme M, Perry ZH. et al. Small bowel perforation after capsule endoscopy in a patient with occult gastrointestinal bleeding and undiagnosed Crohn’s disease. Am Surg 2012; 78: E159-E161
  • 186 De Palma GD, Masone S, Persico M. et al. Capsule impaction presenting as acute small bowel perforation: a case series. J Med Case Rep 2012; 6: 121
  • 187 Jung JH, Choi KD, Ahn JY. et al. Endoscopic submucosal dissection for sessile, nonampullary duodenal adenomas. Endoscopy 2013; 45: 133-135
  • 188 Inoue T, Uedo N, Yamashina T. et al. Delayed perforation: a hazardous complication of endoscopic resection for non-ampullary duodenal neoplasm. Dig Endosc 2014; 26: 220-227
  • 189 Parlak E, Koksal A, Disibeyaz S. et al. Endoscopic closure of ERCP-related duodenal perforations by using endoclips: a case series. Surg Laparosc Endosc Percutan Tech 2013; 23: e225-228
  • 190 Ye LP, Mao XL, Zheng HH. et al. Safety of endoscopic resection for duodenal subepithelial lesions with wound closure using clips and an endoloop: an analysis of 68 cases. Surg Endosc 2017; 31: 1070-1077
  • 191 Krishna RP, Singh RK, Behari A. et al. Post-endoscopic retrograde cholangiopancreatography perforation managed by surgery or percutaneous drainage. Surg Today 2011; 41: 660-666
  • 192 Cordova J, Waxman I, Hart J. et al. Double-balloon endoscopic management of iatrogenic perforation in the small bowel. VideoGIE 2016; 1: 14-15
  • 193 Furukawa K, Miyahara R, Funasaka K. et al. Endoscopic closure of duodenal perforation with the over-the-scope-clipping system. Intern Med 2016; 55: 3131-3135
  • 194 Kirtane T, Singhal S. Endoscopic closure of iatrogenic duodenal perforation using dual over-the-scope clips. Gastrointest Endosc 2016; 83: 467-468
  • 195 Dogan UB, Keskin MB, Soker G. et al. Endoscopic closure of an endoscope-related duodenal perforation using the over-the-scope clip. Turk J Gastroenterol 2013; 24: 436-440
  • 196 Salord S, Gornals JB, Maisterra S. et al. Endoscopic closure of duodenal perforation with an over-the-scope clip during endoscopic ultrasound-guided cholangiopancreatography. Rev Esp Enferm Dig 2012; 104: 489-490
  • 197 Tyberg A, Zerbo S, Sharaiha RZ. et al. Endoscopic management of a GI perforation. Gastrointest Endosc 2015; 82: 955
  • 198 Balmadrid B, Ross A. Severe laceration in a percutaneous endoscopic jejunostomy placement resolved with over-the-scope clips. Gastrointest Endosc 2013; 78: 783-784; discussion 784-785
  • 199 Donatelli G, Dumont JL, Vergeau BM. et al. Colic and gastric over-the-scope clip (Ovesco) for the treatment of a large duodenal perforation during endoscopic retrograde cholangiopancreatography. Therap Adv Gastroenterol 2014; 7: 282-284
  • 200 Khater S, Rahmi G, Perrod G. et al. Over-the-scope clip (OTSC) reduces surgery rate in the management of iatrogenic gastrointestinal perforations. Endosc Int Open 2017; 5: E389-E394 DOI: 10.1055/s-0043-104862.
  • 201 Bergström M, Arroyo Vázquez JA, Park PO. Self-expandable metal stents as a new treatment option for perforated duodenal ulcer. Endoscopy 2013; 45: 222-225
  • 202 Korman LY, Overholt BF, Box T. et al. Perforation during colonoscopy in endoscopic ambulatory surgical centers. Gastrointest Endosc 2003; 58: 554-557
  • 203 Anderson ML, Pasha TM, Leighton JA. Endoscopic perforation of the colon: lessons from a 10-year study. Am J Gastroenterol 2000; 95: 3418-3422
  • 204 Rabeneck L, Paszat LF, Hilsden RJ. et al. Bleeding and perforation after outpatient colonoscopy and their risk factors in usual clinical practice. Gastroenterology 2008; 135: 1899-1906 , 1906.e1891
  • 205 Saunders BP, Fukumoto M, Halligan S. et al. Why is colonoscopy more difficult in women?. Gastrointest Endosc 1996; 43: 124-126
  • 206 Olaiya B, Adler DG. Adverse events after inpatient colonoscopy in octogenarians: results from the national inpatient sample (1998–2013). J Clin Gastroenterol 2019; DOI: 10.1097/mcg.0000000000001288.
  • 207 Mukewar S, Costedio M, Wu X. et al. Severe adverse outcomes of endoscopic perforations in patients with and without IBD. Inflamm Bowel Dis 2014; 20: 2056-2066
  • 208 Rutter MD, Saunders BP, Wilkinson KH. et al. Thirty-year analysis of a colonoscopic surveillance program for neoplasia in ulcerative colitis. Gastroenterology 2006; 130: 1030-1038
  • 209 Bielawska B, Day AG, Lieberman DA. et al. Risk factors for early colonoscopic perforation include non-gastroenterologist endoscopists: a multivariable analysis. Clin Gastroenterol Hepatol 2014; 12: 85-92
  • 210 Wernli KJ, Brenner AT, Rutter CM. et al. Risks associated with anesthesia services during colonoscopy. Gastroenterology 2016; 150: 888-894 ; quiz e818
  • 211 Bielawska B, Hookey LC, Sutradhar R. et al. Anesthesia assistance in outpatient colonoscopy and risk of aspiration pneumonia, bowel perforation, and splenic injury. Gastroenterology 2018; 154: 77-85 .e73
  • 212 Luning TH, Keemers-Gels ME, Barendregt WB. et al. Colonoscopic perforations: a review of 30,366 patients. Surg Endosc 2007; 21: 994-997
  • 213 Hawkins AT, Sharp KW, Ford MM. et al. Management of colonoscopic perforations: A systematic review. Am J Surg 2018; 215: 712-718
  • 214 Putcha RV, Burdick JS. Management of iatrogenic perforation. Gastroenterol Clin North Am 2003; 32: 1289-1309
  • 215 Derbyshire E, Hungin P, Nickerson C. et al. Colonoscopic perforations in the English national health service bowel cancer screening programme. Endoscopy 2018; 50: 861-870
  • 216 Tribonias G, Konstantinidis K, Theodoropoulou A. et al. Rectal perforation caused by colonoscopic retroflexion. Gastrointest Endosc 2010; 71: 662
  • 217 Loffeld RJ, Engel A, Dekkers PE. Incidence and causes of colonoscopic perforations: a single-center case series. Endoscopy 2011; 43: 240-242
  • 218 Stock C, Ihle P, Sieg A. et al. Adverse events requiring hospitalization within 30 days after outpatient screening and non-screening colonoscopies. Gastrointest Endosc 2013; 77: 419-429
  • 219 Lee TJ, Rutter MD, Blanks RG. et al. Colonoscopy quality measures: experience from the NHS Bowel Cancer Screening Programme. Gut 2012; 61: 1050-1057
  • 220 Rabeneck L, Saskin R, Paszat LF. Onset and clinical course of bleeding and perforation after outpatient colonoscopy: a population-based study. Gastrointest Endosc 2011; 73: 520-523
  • 221 Morar PS, Faiz O, Warusavitarne J. et al. Systematic review with meta-analysis: endoscopic balloon dilatation for Crohn’s disease strictures. Aliment Pharmacol Ther 2015; 42: 1137-1148
  • 222 Bettenworth D, Gustavsson A, Atreja A. et al. A pooled analysis of efficacy, safety, and long-term outcome of endoscopic balloon dilation therapy for patients with stricturing crohn's disease. Inflamm Bowel Dis 2017; 23: 133-142
  • 223 van Hooft JE, van Halsema EE, Vanbiervliet G. et al. Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Gastrointest Endosc 2014; 80: 747-761 .e1-75
  • 224 van Halsema EE, van Hooft JE, Small AJ. et al. Perforation in colorectal stenting: a meta-analysis and a search for risk factors. Gastrointest Endosc 2014; 79: 970-982 .e977; quiz 983.e972, 983.e975
  • 225 Bowles CJ, Leicester R, Romaya C. et al. A prospective study of colonoscopy practice in the UK today: are we adequately prepared for national colorectal cancer screening tomorrow?. Gut 2004; 53: 277-283
  • 226 Heldwein W, Dollhopf M, Rosch T. et al. The Munich Polypectomy Study (MUPS): prospective analysis of complications and risk factors in 4000 colonic snare polypectomies. Endoscopy 2005; 37: 1116-1122
  • 227 Arezzo A, Passera R, Marchese N. et al. Systematic review and meta-analysis of endoscopic submucosal dissection vs endoscopic mucosal resection for colorectal lesions. United European Gastroenterol J 2016; 4: 18-29
  • 228 Kothari ST, Huang RJ, Shaukat A. et al. ASGE review of adverse events in colonoscopy. Gastrointest Endosc 2019; 90: 863-876.e33
  • 229 Fujiya M, Tanaka K, Dokoshi T. et al. Efficacy and adverse events of EMR and endoscopic submucosal dissection for the treatment of colon neoplasms: a meta-analysis of studies comparing EMR and endoscopic submucosal dissection. Gastrointest Endosc 2015; 81: 583-595
  • 230 Hong SN, Byeon JS, Lee BI. et al. Prediction model and risk score for perforation in patients undergoing colorectal endoscopic submucosal dissection. Gastrointest Endosc 2016; 84: 98-108
  • 231 La Torre M, Velluti F, Giuliani G. et al. Promptness of diagnosis is the main prognostic factor after colonoscopic perforation. Colorectal Dis 2012; 14: e23-26
  • 232 Bassan MS, Holt B, Moss A. et al. Carbon dioxide insufflation reduces number of postprocedure admissions after endoscopic resection of large colonic lesions: a prospective cohort study. Gastrointest Endosc 2013; 77: 90-95
  • 233 Gayer G, Hertz M, Zissin R. Postoperative pneumoperitoneum: prevalence, duration, and possible significance. Semin Ultrasound CT MR 2004; 25: 286-289
  • 234 Raju GS, Ahmed I, Xiao SY. et al. Controlled trial of immediate endoluminal closure of colon perforations in a porcine model by use of a novel clip device (with videos). Gastrointest Endosc 2006; 64: 989-997
  • 235 Burgess NG, Bassan MS, McLeod D. et al. Deep mural injury and perforation after colonic endoscopic mucosal resection: a new classification and analysis of risk factors. Gut 2017; 66: 1779-1789
  • 236 Ma MX, Bourke MJ. Complications of endoscopic polypectomy, endoscopic mucosal resection and endoscopic submucosal dissection in the colon. Best Pract Res Clin Gastroenterol 2016; 30: 749-767
  • 237 Magdeburg R, Collet P, Post S. et al. Endoclipping of iatrogenic colonic perforation to avoid surgery. Surg Endosc 2008; 22: 1500-1504
  • 238 Byeon JS. Colonic perforation: can we manage it endoscopically?. Clin Endosc 2013; 46: 495-499
  • 239 Kim ES, Cho KB, Park KS. et al. Factors predictive of perforation during endoscopic submucosal dissection for the treatment of colorectal tumors. Endoscopy 2011; 43: 573-578
  • 240 Magdeburg R, Sold M, Post S. et al. Differences in the endoscopic closure of colonic perforation due to diagnostic or therapeutic colonoscopy. Scand J Gastroenterol 2013; 48: 862-867
  • 241 Jovanovic I, Zimmermann L, Fry LC. et al. Feasibility of endoscopic closure of an iatrogenic colon perforation occurring during colonoscopy. Gastrointest Endosc 2011; 73: 550-555
  • 242 Singhal S, Changela K, Papafragkakis H. et al. Over the scope clip: technique and expanding clinical applications. J Clin Gastroenterol 2013; 47: 749-756
  • 243 Weiland T, Fehlker M, Gottwald T. et al. Performance of the OTSC system in the endoscopic closure of iatrogenic gastrointestinal perforations: a systematic review. Surg Endosc 2013; 27: 2258-2274
  • 244 Alsowaina KN, Ahmed MA, Alkhamesi NA. et al. Management of colonoscopic perforation: a systematic review and treatment algorithm. Surg Endosc 2019; 33: 3889-3898
  • 245 Han JH, Park S, Youn S. Endoscopic closure of colon perforation with band ligation; salvage technique after endoclip failure. Clin Gastroenterol Hepatol 2011; 9: e54-55
  • 246 Ryu JY, Park BK, Kim WS. et al. Endoscopic closure of iatrogenic colon perforation using dual-channel endoscope with an endoloop and clips: methods and feasibility data (with videos). Surg Endosc 2019; 33: 1342-1348
  • 247 Kantsevoy SV, Bitner M, Hajiyeva G. et al. Endoscopic management of colonic perforations: clips versus suturing closure (with videos). Gastrointest Endosc 2016; 84: 487-493
  • 248 Cho SB, Lee WS, Joo YE. et al. Therapeutic options for iatrogenic colon perforation: feasibility of endoscopic clip closure and predictors of the need for early surgery. Surg Endosc 2012; 26: 473-479
  • 249 Bleier JI, Moon V, Feingold D. et al. Initial repair of iatrogenic colon perforation using laparoscopic methods. Surg Endosc 2008; 22: 646-649