Amy Tyberg, MD, from the Division of Gastroenterology and Hepatology at Weil Cornell Medical College, Cornell University in New York, New York, USA shares this VideoGIE case “Endoscopic management of a GI perforation.”
This case describes a 55-year-old woman with Roux-en-Y anatomy who developed a full-thickness jejunal perforation during an endoscopic procedure. This adverse event was immediately recognized, and the patient was managed endoscopically with placement of 2 over-the-scope clips for closure. No surgical intervention was required.
This video illustrates the changing endoscopic landscape and the expanding role of endoscopy in the management of patients. More specifically, it provides an example of how adverse events that previously required surgical intervention can often now be safely managed endoscopically without the need for surgical intervention.
In patients with gastrointestinal perforations, 4 key steps can be used to safely manage the patient without the need for immediate surgery. Stabilizing the patient by giving antibiotics and by decompressing the abdomen, either via direct suctioning of the peritoneal cavity or by abdominal needle decompression, is the first key step in management. Subsequently, it is critical to choose a closure technique based on the location and size of the lesion and then close the lesion using the chosen technique. And lastly, the final step involves confirming adequate closure with contrast injection under fluoroscopy to ensure no leakage of contrast. By performing these key steps, patients with perforations can be safely treated without the need for more invasive surgical interventions.
We hope this video will not only provide an algorithm as to how to manage endoscopic perforations, but also inspire confidence for all gastroenterologists in the ability to manage adverse events endoscopically.
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