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This article presents a survey of endoscopy units in the United Kingdom to identify the factors associated with oesophageal perforation during the procedure. The study finds that perforation is rare in diagnostic procedures but more common in therapeutic endoscopy, particularly palliative intubation. Some of the key risk factors identified include difficult intubation, inexperienced operators, elderly patients, and the presence of a tight stricture.

Methodology and Results

• The survey included 173 endoscopy units in the UK and received responses from 101 of them. The respondents reported serious complications in their units.
• A further questionnaire was sent to the units that reported serious complications, and 24 responded with more details.
• In general, oesophageal perforation during diagnostic oesophagogastroduodenoscopy was found to be rare, with one in 5474 examinations.
• The study identified that patients with reported cases of perforation were usually older and had undergone a barium swallow procedure before endosopy. In addition, in many of these cases, intubation was performed by inexperienced operators.

Comparison between Diagnostic and Therapeutic Endoscopy

• Perforation during oesophageal dilatation, a therapeutic procedure, was more common than during diagnostic endoscopy, occurring in one in 109 procedures.
• The study noted that perforation often occurred despite previous radiological visualisation of the stricture and typically at the first or second dilatation.
• A significant finding was that palliative oesophageal intubation for carcinoma posed a high risk, with perforation occurring in one in 13 procedures. This was common even though a barium swallow procedure had been performed in most of these patients prior to the procedure.

Conclusions and Implications

• The study concludes that while perforation is relatively rare in diagnostic procedures, the risk is higher in therapeutic endoscopy, especially palliative intubation.
• It identifies difficult intubation, inexperienced operators, elderly patients, and the presence of a tight stricture as key risk factors associated with oesophageal perforation.
• The study highlights that heavy sedation is often used in cases where perforation occurs during dilatation, and that staging of the procedure does not prevent complications.
• Finally, the authors emphasize that contrary to some views, prior radiology does not prevent perforation during endoscopy.