title: The Endoscopic Treatment of Iatrogenic Gastrointestinal Perforation.
abstract: BACKGROUND
  Iatrogenic gastrointestinal perforation is a life-threatening complication that arises very rarely in routine endoscopic procedures, with an incidence of 0.03-0.8%. It is more likely in highly complex and invasive therapeutic interventions. In certain situations, endoscopic closure of the perforation and treatment with antibiotics can obviate the need for emergency surgical repair.
  
  
  METHODS
  This review is based on pertinent articles retrieved by a selective literature search in PubMed and on a relevant position paper.
  
  
  RESULTS
  Existing clinical studies of treatment for iatrogenic gastrointestinal perforation are mainly retrospective and uncontrolled. No randomized and controlled trials have been performed to date. If the perforation is discovered soon after it arises, endoscopic treatment can be considered. Gastrointestinal perforations that are less than 30 mm in size can be closed with a clip. In the esophagus, expanding metal stents can be used as well. Clip application is successful in 80-100% of cases of gastrointestinal perforation, and the perforation remains permanently closed in 60-100% of cases. Reports on the endoscopic treatment of esophageal perforation show mixed results, with closure rates of roughly 90% and clinical success rates of roughly 80%. If endoscopic treatment is not possible, timely laparoscopic or open surgical repair is needed.
  
  
  CONCLUSIONS
  The endoscopic treatment of iatrogenic perforations is safe and reliable. Success depends on early detection, adequate endoscopic closure with properly mastered technique, and the early initiation of concomitant antibiotic treatment, which must be continued for a full course. Most patients who are treated in this way do not need emergency surgery.
authors.affiliation: Department of Internal Medicine, Gastroenterology and Oncology, Klinikum Ludwigsburg, Department of General, Visceral and Thoracic Surgery,, AGAPLESION Markus Krankenhaus Frankfurt am Main, Ulm University Hospital Medical Center, Department of Internal Medicine I.
authors.forename: Arthur
authors.initials: A
authors.lastname: Schmidt
authors.forename: Karl-Hermann
authors.initials: KH
authors.lastname: Fuchs
authors.forename: Karel
authors.initials: K
authors.lastname: Caca
authors.forename: Armin
authors.initials: A
authors.lastname: Küllmer
authors.forename: Alexander
authors.initials: A
authors.lastname: Meining
mesh_terms: D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects* / Q000379:methods*; D019317:Evidence-Based Medicine; D005858:Germany; D006801:Humans; D007049:Iatrogenic Disease / Q000517:prevention & control; D007416:Intestinal Perforation / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D016896:Treatment Outcome