Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement
Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement
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DOI：
10.1055/s-0034-1377531
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发表时间：
2014-08-01
期刊：
影响因子：
9.3
通讯作者：
Hassan, Cesare
中科院分区：
文献类型：
--
作者：
Paspatis, Gregorios A.;Dumonceau, Jean-Marc;Hassan, Cesare
本立场文件是欧洲胃肠内窥镜学会（ESGE）的官方声明。主要说明1 ESGE建议每家中心实施关于医源性穿孔管理的书面政策，包括对具有高并发症风险的手术的定义。该政策应与每个中心的放射科医生和外科医生共享。2在内窥镜检查发现穿孔的情况下，ESGE建议内窥镜医生报告：穿孔的大小和位置以及图片;可能的内窥镜治疗;是否使用二氧化碳或空气吹入;和标准报告信息。3ESGE建议应仔细评估和记录内镜手术后提示医源性穿孔的症状或体征，可能进行计算机断层扫描（CT），以防止任何诊断延迟。4 ESGE建议，应根据穿孔类型、大小和中心内镜医师的专业知识考虑内镜闭合。转换为二氧化碳吹入，腔内容物的分流，以及张力性气腹或张力性气胸的减压也应该进行。5在使用内窥镜方法闭合医源性穿孔后，ESGE建议进一步的管理应该基于估计的内窥镜闭合成功率和患者的一般临床状况。在没有或失败的内镜关闭医源性穿孔的情况下，以及在临床状况恶化的患者中，建议住院和外科会诊。
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 recommendations1ESGE 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.2In 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.3ESGE 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.4ESGE 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.5After 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.