Endoscopy 2019; 51(04): S196
DOI: 10.1055/s-0039-1681752
ESGE Days 2019 ePoster podium presentations
Saturday, April 6, 2019 14:00 – 14:30: Complications ePoster Podium 8
Georg Thieme Verlag KG Stuttgart · New York

APP (AMBERG-PERFORATION-PROJECT) – DEVELOPMENT AND EVALUATION OF AN INTERDISCIPLINARY, SYSTEMATIC APPROACH FOR ENDOSCOPIC MANAGEMENT OF IATROGENIC PERFORATION IN A GERMAN SECONDARY REFERRAL CENTER

T Decassian
1   Klinikum St. Marien Amberg, Amberg, Germany
,
M Dauer
1   Klinikum St. Marien Amberg, Amberg, Germany
,
V Groß
1   Klinikum St. Marien Amberg, Amberg, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

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Aims:

In recent years there has been a shift of paradigm in the management of iatrogenic gastrointestinal perforations from surgical towards primary endoscopic management. In order to establish and evaluate this concept in our own hospital, we developed the Amberg-perforation-Project.

Methods:

All perforations occuring in more than 18.000 consecutive gastrointestinal endoscopies in our department from I/2014 until IV/2017 were recorded, evaluated, and followed-up prospectively. In-house SOPs were designed and communicated with all physicians in our hospital. Primary goal was endoscopic closure of the perforation.

Results:

In total, we observed 24 perforations in 18.627 consecutive endoscopies (0,13%):

  • EGD + push-enteroscopy: 7/9.508 (0,07%) (4 therapeutic/3 diagnostic)

  • colonoscopy + sigmoidoscopy, diagnostic: 3/6.958 (0,04%)

  • polypectomy (including EMR/ESD): 4/1.577 (0,25%)

  • ERCP: 9/1.537 (0,59%)

  • EUS: 1/642 (0,16%)

In addition, 24 cases of extraluminal gas without detectable perforation could be identified: 12 post-polypectomy and 12 following ERCP (Stapfer-4). Diagnosis of perforation could be established within 12 hours in 95,8% (23/24) (in 20 cases during endoscopy). Initial therapeutic approach was surgical in 3 cases, conservative in 3 cases, and endoscopic in 17 cases (4x Clips, 10x OTSC, 3x SEMS). In 1 case no therapy could be performed (outpatient with delayed admittance to our emergency unit). Mortality was 4,2% (1/24). In 3 cases, patients had to be operated on secondary to endoscopic therapy. Endoscopic treatment showed a technical and a clinical success rate of 94,1% (16/17) and 87,5% (14/16) respectively.

Conclusions:

Primary endoscopic management of iatrogenic gastrointestinal perforations is safe and highly successful in everyday practice of a secondary referral center. Based on the findings of our study, we established a system for documentation and management of endoscopic complications („KEMS“), that was successfully integrated in our IT-based patient management system (KIS).