Diagnose und Management iatrogener endoskopischer Perforationen: Positionspapier der Europäischen Gesellschaft für Gastrointestinale Endoskopie (ESGE)

Zusammenfassung

Dieses Positionspapier ist eine offizielle Stellungnahme der Europäischen Gesellschaft für Gastrointestinale Endoskopie (ESGE). Es behandelt die Diagnose und das Management iatrogener Perforationen, die während diagnostischer und therapeutischer Endoskopien entstehen.

Hauptempfehlungen

1. Die ESGE empfiehlt, dass jedes Zentrum schriftlich festlegt, wie das Management iatrogener Komplikationen zu erfolgen hat, einschließlich der Definition von Eingriffen, die ein hohes Komplikationsrisiko aufweisen. Die Vorgehensweise sollte in jedem Zentrum mit den Radiologen und Chirurgen abgestimmt werden.

2. Wird endoskopisch eine Perforation identifiziert, empfiehlt die ESGE den Endoskopikern die Bilddokumentation von Größe und Lokalisation, die Angabe von möglichen endoskopischen Behandlungsoptionen, die Angabe, ob Luft oder CO₂ für die Insufflation verwendet wurde, sowie einen Standardbericht.

3. Die ESGE empfiehlt die sorgfältige Bewertung und Dokumentation von Symptomen oder Zeichen, die für eine iatrogene Perforation nach einem Eingriff sprechen, nach Möglichkeit mit einer Computertomografie (CT), um einer Verzögerung der Diagnostik vorzubeugen.

4. Die ESGE empfiehlt, dass ein endoskopischer Verschluss in Abhängigkeit von der Art der Perforation, ihrer Größe und der am Zentrum verfügbaren endoskopischen Expertise erwogen wird. Außerdem sollte auf eine CO₂-Insufflation umgeschaltet werden, die Diversion des Hohlrauminhaltes und die Entlastung eines Spannungspneumoperitoneums oder Spannungspneumothorax erfolgen.

5. Nach endoskopischem Verschluss einer iatrogenen Perforation empfiehlt die ESGE das weitere Management in Abhängigkeit vom möglichen Behandlungserfolg und dem Allgemeinzustand des Patienten festzulegen. Erfolgt kein endoskopischer Verschluss oder misslingt dieser sowie bei sich verschlechterndem Allgemeinzustand wird die stationäre Aufnahme und die Konsultation des Chirurgen empfohlen.

Abstract

This Position Paper is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). It addresses the diagnosis and management of iatrogenic perforation occurring during diagnostic or therapeutic digestive endoscopic procedures.

Main recommendations

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

2. In the case of an endoscopically identified perforation, ESGE recommends that the endoscopist reports: its size and location with a picture; endoscopic treatment that might have been possible; whether carbon dioxide or air was used for insufflation; and the standard report information.

3. ESGE recommends that symptoms or signs suggestive of iatrogenic perforation after an endoscopic procedure should be carefully evaluated and documented, possibly with a computed tomography (CT) scan, in order to prevent any diagnostic delay.

4. ESGE recommends that endoscopic closure should be considered depending on the type of perforation, its size, and the endoscopist expertise available at the center. A switch to carbon dioxide insufflation, the diversion of luminal content, and decompression of tension pneumoperitoneum or tension pneumothorax should also be done.

5. After closure of an iatrogenic perforation using an endoscopic method, ESGE recommends that 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 the iatrogenic perforation, and in patients whose clinical condition is deteriorating, hospitalization and surgical consultation are recommended.

Schlüsselwörter

iatrogene Perforation - Endoskopie - Clips - Chirurgie - Computertomografie - endoskopische Resektion - ERCP

Key words

iatrogenic perforation - endoscopy - clips - surgery - computed tomography - endoscopic resection - ERCP

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