The following is a summary of “Identification of Iatrogenic Perforation in Pediatric Gastrointestinal Endoscopy,” published in the September 2023 issue of Pediatrics by Ledder, et al.
Iatrogenic viscus perforation during pediatric gastrointestinal endoscopy (GIE) is a rare but potentially life-threatening occurrence. There are no established guidelines for post-procedure follow-up to detect and manage perforations. For a study, researchers sought to understand better the presentation of children with post-GIE perforations to formulate post-procedure recommendations.
The retrospective study gathered data from various centers in Europe, North America, and the Middle East associated with the Endoscopy Special Interest Groups of the European Society for Paediatric Gastroenterology Hepatology and Nutrition and the North American Society for Pediatric Gastroenterology Hepatology and Nutrition. Information on procedural and patient data related to the clinical presentation of perforations was collected using standardized REDCap case report forms.
A total of 59 cases of viscus perforation were recorded. The median age of the patients was 6 years. Among these cases, 49% occurred after esophagogastroduodenoscopy, 44% after ileocolonoscopy, and 3% each after balloon enteroscopy and endoscopic retrograde cholangiopancreatography. In 48% of cases, perforations, mainly endoscopically, were identified during the procedure. An additional 9% of cases were identified within 4 hours, and 80% were identified within 12 hours. Of the perforations identified post-procedure, 61% presented with pain, 52% with fever, and 32% with abdominal rigidity or dyspnea. Surgical management was required in 51% of cases, conservative management in 29%, and endoscopic management in 15%. Unfortunately, 7% of patients died, all following esophageal perforation.
The study found that iatrogenic perforations were identified in more than half of cases immediately and in 80% of cases within 12 hours. The findings can inform the development of post-procedural follow-up and monitoring guidelines.