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Endoscopic perforations: what are the indications for surgery?

Endoscopic perforations: what are the indications for surgery? Background Despite their low occurrence, endoscopic perforations (EPs) are concerning. Some predictive factors have been identified, and EP management is debated, whether non-surgical (medical and/or endoscopic) or surgical. The objective was to elaborate a predictive score for surgical management of EP. Methods All the patients addressed for upper and lower EP, except oesophageal EP, were retrospectively included (2004– 2015). Demographic data, endoscopic features (indication, location, type), clinical, biological and radiological presentations of EP were reviewed. Management of EP and outcomes were recorded. A predictive score was constructed by multiple linear regression and a cut-off value for surgical management was identified. Additional subgroup analysis was performed accord- ing to the location of EP (upper and lower). Results Among 41150 endoscopic procedures, 44 patients (22 males, median age = 65 years [22–87]) presenting with EP were included (0.09%). Lower gastrointestinal (GI) endoscopy was mostly performed (66%). EP diagnosis was immediate in 73% of the cases (n = 32). Non-surgical management was efficient in 2/3 cases treated medically alone, and 18/20 cases treated by endoscopy. Surgical management was always successful (n = 24/24). In case of peritonitis, surgery was systematically required, whereas easily required in case of delayed diagnostic of EP. The EP http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Surgical Endoscopy Springer Journals

Endoscopic perforations: what are the indications for surgery?

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Publisher
Springer Journals
Copyright
Copyright © 2018 by Springer Science+Business Media, LLC, part of Springer Nature
Subject
Medicine & Public Health; Surgery; Gynecology; Gastroenterology; Hepatology; Proctology; Abdominal Surgery
ISSN
0930-2794
eISSN
1432-2218
DOI
10.1007/s00464-018-6043-1
Publisher site
See Article on Publisher Site

Abstract

Background Despite their low occurrence, endoscopic perforations (EPs) are concerning. Some predictive factors have been identified, and EP management is debated, whether non-surgical (medical and/or endoscopic) or surgical. The objective was to elaborate a predictive score for surgical management of EP. Methods All the patients addressed for upper and lower EP, except oesophageal EP, were retrospectively included (2004– 2015). Demographic data, endoscopic features (indication, location, type), clinical, biological and radiological presentations of EP were reviewed. Management of EP and outcomes were recorded. A predictive score was constructed by multiple linear regression and a cut-off value for surgical management was identified. Additional subgroup analysis was performed accord- ing to the location of EP (upper and lower). Results Among 41150 endoscopic procedures, 44 patients (22 males, median age = 65 years [22–87]) presenting with EP were included (0.09%). Lower gastrointestinal (GI) endoscopy was mostly performed (66%). EP diagnosis was immediate in 73% of the cases (n = 32). Non-surgical management was efficient in 2/3 cases treated medically alone, and 18/20 cases treated by endoscopy. Surgical management was always successful (n = 24/24). In case of peritonitis, surgery was systematically required, whereas easily required in case of delayed diagnostic of EP. The EP

Journal

Surgical Endoscopy – Springer Journals

Published: Jan 16, 2018

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