Post written by Natalie Wilson, MD, from the Department of Internal Medicine, University of Minnesota, Minneapolis, Minneapolis, USA, and Mohammad Bilal, MD, from the Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA.

Our video Review Article illustrates the use of percutaneous needle decompression to manage pneumoperitoneum during advanced endoscopic procedures. This video features 2 cases where percutaneous needle decompression was successfully used for management of pneumoperitoneum: 1 was a perforation during endoscopic submucosal dissection of a colorectal polyp, and the second was during submucosal tunnel endoscopic resection of a gastric GI stromal tumor.

In both cases, needle decompression resulted in normalization of elevated peak ventilatory pressures (from pneumoperitoneum) and improvement in abdominal distension, such that the procedures were able to be continued successfully, and both defects were closed endoscopically.

With the rise of advanced therapeutic endoscopic techniques, it has become increasingly important for endoscopists to recognize and manage procedure-related adverse events. Percutaneous needle decompression is a potentially life-saving intervention for managing pneumoperitoneum during endoscopic procedures. However, guidance in the literature on how to perform this technique is limited. We felt it was important to create a practical video that serves as a step-by-step procedural guide with real-life case examples to improve understanding and awareness of this technique. 

This experience highlights the importance of early recognition and management of procedure-related adverse events such as perforation, particularly as endoscopic techniques continue to evolve. For example, endoscopic procedures associated with high rates of pneumoperitoneum include endoscopic submucosal dissection, EMR of large lesions, endoscopic full-thickness resection, and peroral endoscopic myotomy.

Pneumoperitoneum also can occur with third-space procedures of extended duration even in the absence of full-thickness perforation. Percutaneous needle decompression can allow time for endoscopic closure in cases of perforation or serve as a temporizing measure prior to surgical intervention. We hope this video article can provide a useful and practical guide for endoscopists to feel comfortable performing this technique in their practice if necessary.

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Read the full article online.

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