Pediatric endoscopic injuries: incidence, management, and outcomes.
BACKGROUND
Endoscopy has assumed a significant role in the management of gastrointestinal disorders. However, endoscopic-related injuries are poorly reported.


METHODS
Review of our surgical database (1980-2006) identified all patients age 18 years or younger with an endoscopic-related injury managed at our institution.


RESULTS
A total of 3269 colonoscopies were performed; there were 3 iatrogenic perforations (incidence, 0.09%). All were managed operatively: 2 underwent fecal diversion, and 1 was repaired primarily. There was 1 postoperative complication (internal hernia) and no deaths related to colonoscopic perforation. Nine thousand three hundred eight esophagogastroduodenoscopy (EGD) procedures were performed, resulting in 6 iatrogenic injuries (0.06%): bleeding (2), perforation (2), and mucosal tears (2) (0.02% each). All EGD-related injuries occurred in the esophagus except for 1 duodenal perforation which was managed operatively by primary repair. Both patients with bleeding complications underwent repeat endoscopy and cautery with satisfactory results. The other 3 patients were managed conservatively without complication. Three hundred eighty-nine endoscopic retrograde cholangiopancreatogram procedures were performed with 2 iatrogenic injuries (0.5%): 1 bleed and 1 perforation (0.25% each). Both were managed conservatively without complication.


CONCLUSIONS
Endoscopic injuries are uncommon. Colonoscopic perforations require prompt surgical intervention. Esophagogastroduodenoscopy- and endoscopic retrograde cholangiopancreatogram-related injuries are amenable to conservative therapy in clinically stable patients devoid of peritonitis.
Iqbal
Corcy W
CW
Division of General and Gastroenterological Surgery, Department of Surgery, Mayo Clinic Rochester, MN 55905, USA.
Askegard-Giesmann
Johanna R
JR
Pham
Tuan H
TH
Ishitani
Michael B
MB
Moir
Christopher R
CR
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000706:statistics & numerical data; D003113:Colonoscopy / Q000009:adverse effects / Q000706:statistics & numerical data; D004724:Endoscopy / Q000009:adverse effects* / Q000706:statistics & numerical data; D004947:Esophagus / Q000293:injuries; D005260:Female; D005767:Gastrointestinal Diseases / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology*; D015994:Incidence; D007223:Infant; D007413:Intestinal Mucosa / Q000293:injuries*; D007416:Intestinal Perforation / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D012189:Retrospective Studies