BACKGROUND Upper gastrointestinal endoscopic examination is a relatively safe procedure; however, all endoscopic procedures are invasive and are associated with a risk of iatrogenic perforation. To evaluate clinical outcomes of iatrogenic upper gastrointestinal endoscopic perforation. Factors associated with surgical management or mortality were analyzed. METHODS Between November 2008 and November 2018, the medical records of 149,792 upper gastrointestinal endoscopic procedures were evaluated. The mechanisms of perforations were categorized as electrocoagulation-induced or blunt trauma-induced injuries. The incidence and clinical outcomes of iatrogenic perforations based on the types of procedures performed were evaluated. RESULTS Iatrogenic endoscopic perforations occurred in 28 cases (0.019%). Iatrogenic perforation-related mortality occurred in 3 patients. The iatrogenic perforation rate based on the types of procedures performed was as follows: diagnostic endoscopy = 0.002%, duodenal endoscopic mucosal resection = 0.9%, esophageal endoscopic submucosal dissection = 10.7%, gastric endoscopic submucosal dissection = 0.2%, endoscopic self-expandable metal stent insertion for malignant esophageal obstruction = 0.1%, duodenoscope-induced injury = 0.02%, endoscopic sphincterotomy = 0.08%, and ampullectomy = 6.8%. All electrocoagulation-induced perforations (n = 21) were managed successfully (15 cases of endoscopic closure, 5 cases treated conservatively, and 1 case treated surgically). Three patients died among those with blunt trauma-induced perforations (n = 7). The factors associated with surgical management or mortality were old age, poor performance status (Eastern Cooperative Oncology Group score ≥ 1), advanced malignancy, and blunt trauma. CONCLUSIONS Most cases of electrocoagulation-induced iatrogenic perforations can be treated using endoscopic clips. If endoscopic closure fails for blunt trauma-induced perforations, prompt surgical management is mandatory.

中文翻译：

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医源性上消化道内窥镜穿孔的临床结果：一项为期10年的研究。

背景技术上消化道内窥镜检查是一种相对安全的方法。但是，所有内窥镜检查程序都是侵入性的，并伴有医源性穿孔的风险。评估医源性上消化道内镜穿孔的临床效果。分析与手术管理或死亡率相关的因素。方法在2008年11月至2018年11月期间，对149792例上消化道内镜手术的病历进行了评估。穿孔的机制可分为电凝引起的或钝性创伤引起的损伤。根据执行的手术类型评估了医源性穿孔的发生率和临床结局。结果医源性内窥镜穿孔发生28例（0.019％）。与医源性穿孔相关的死亡发生在3例患者中。根据执行的程序类型，医源性穿孔率如下：诊断性内窥镜检查= 0.002％，十二指肠内镜下黏膜切除术= 0.9％，食道内镜下黏膜下剥离术= 10.7％，胃内镜下黏膜下剥离术= 0.2％，内镜自扩张金属食管恶性梗阻置入支架= 0.1％，十二指肠镜引起的损伤= 0.02％，内窥镜括约肌切开术= 0.08％，壶腹切除术= 6.8％。所有电凝引起的穿孔（21例）均得到成功处理（内镜闭合15例，保守治疗5例，手术治疗1例）。钝性穿孔导致穿孔的患者中有3例死亡（n = 7）。与手术管理或死亡率相关的因素包括老年，表现不佳（东部合作肿瘤小组评分≥1），晚期恶性肿瘤和钝性创伤。结论大多数电凝引起的医源性穿孔的病例都可以使用内窥镜夹钳治疗。如果内窥镜闭合因钝性创伤引起的穿孔而失败，则必须立即进行外科手术处理。