Complications of diagnostic and therapeutic oesoph

Complications of diagnostic and therapeutic oesophagogastroduodenoscopy

Diagnostic upper gastrointestinal endoscopy is a safe proce dure with minimal morbidity as long as appropriate patient selection and safe sedation practices are embedded in the unit’s policy . The rate of serious complications is approximately 1:10 /uni00A0 000. The majority of adverse events relate to sedation and patient comorbidity . Particular caution should be exer - cised in patients with recent unstable cardiac ischaemia and respiratory compromise. Perforation can occur at any point in the upper gastrointestinal tract, including the oropharynx. It is rare during diagnostic procedures and is usually associated with inexperience. Perforation is more common in therapeutic endoscopy , particularly oesophageal dilatation and EMR/ESD for early malignancy . Early diagnosis significantly improves outcome and can potentially be managed endoscopically with clips or endoscopic suturing. Prompt management includes radiological assessment using CT/water-soluble contrast studies, strict nil by mouth, intravenous fluids and antibiotics and early review by an expe - rienced upper gastrointestinal surgeon. Summary box 9.5 Symptoms of endoscopic oesophageal perforation /uni25CF /uni25CF - /uni25CF /uni25CF /uni25CF /uni25CF low-

Figure 9.9 A self-expanding metal stent may alle

viate symptoms relating to malignant oesophageal strictures. (Left) An endoscopic view of a deployed stent, and (right) the radiographic image.

Neck/chest pain Increasing tachycardia Dysphagia/drooling saliva Hypotension Abdominal pain Surgical emphysema

Complications of diagnostic and therapeutic oesophagogastroduodenoscopy

Diagnostic upper gastrointestinal endoscopy is a safe proce dure with minimal morbidity as long as appropriate patient selection and safe sedation practices are embedded in the unit’s policy . The rate of serious complications is approximately 1:10 /uni00A0 000. The majority of adverse events relate to sedation and patient comorbidity . Particular caution should be exer - cised in patients with recent unstable cardiac ischaemia and respiratory compromise. Perforation can occur at any point in the upper gastrointestinal tract, including the oropharynx. It is rare during diagnostic procedures and is usually associated with inexperience. Perforation is more common in therapeutic endoscopy , particularly oesophageal dilatation and EMR/ESD for early malignancy . Early diagnosis significantly improves outcome and can potentially be managed endoscopically with clips or endoscopic suturing. Prompt management includes radiological assessment using CT/water-soluble contrast studies, strict nil by mouth, intravenous fluids and antibiotics and early review by an expe - rienced upper gastrointestinal surgeon. Summary box 9.5 Symptoms of endoscopic oesophageal perforation /uni25CF /uni25CF - /uni25CF /uni25CF /uni25CF /uni25CF low-

Figure 9.9 A self-expanding metal stent may alle

viate symptoms relating to malignant oesophageal strictures. (Left) An endoscopic view of a deployed stent, and (right) the radiographic image.

Neck/chest pain Increasing tachycardia Dysphagia/drooling saliva Hypotension Abdominal pain Surgical emphysema