Endoscopic perforations: what are the indications for surgery?

Area of Science:

• Gastroenterology
• Surgical Endoscopy
• Medical Informatics

Background:

• Endoscopic perforations (EPs) are rare but serious complications of endoscopic procedures.
• Management strategies for EPs, including non-surgical and surgical options, remain a subject of debate.
• Identifying factors to guide surgical decision-making is crucial for optimal patient outcomes.

Purpose of the Study:

• To develop a predictive score to guide the surgical management of endoscopic perforations (EPs).
• To establish a reliable tool for differentiating between patients requiring surgical intervention versus non-surgical management for EPs.

Main Methods:

• A retrospective analysis of patients undergoing upper and lower gastrointestinal endoscopy between 2004 and 2015 was conducted.
• Data collected included patient demographics, endoscopic details, clinical presentation, and management outcomes.
• A predictive score for surgical management was constructed using multiple linear regression, with subgroup analyses based on perforation location.

Main Results:

• Out of 41,150 procedures, 44 patients (0.09%) experienced EPs, predominantly from lower GI endoscopy.
• Non-surgical management was successful in most cases (2/3 medically, 18/20 endoscopically). Surgical management was universally successful (24/24).
• A predictive EP score, incorporating factors like prior abdominal surgery and diagnostic endoscopy, was developed with a cut-off of 22.8% for surgical indication, showing 100% sensitivity.

Conclusions:

• The developed predictive EP score can assist in optimizing surgical management decisions, potentially preventing unnecessary surgeries or treatment delays.
• Prospective validation of this predictive score is recommended for future studies.
• The score demonstrated effectiveness in guiding surgical intervention based on perforation location and clinical presentation.