Aims:
Acute iatrogenic perforations are one of the recognized complications of both diagnostic
and therapeutic gastrointestinal endoscopy. For decades, surgical treatment has been
the standard of care, but endoscopic closure has become a more popular approach, due
to feasibility and the reduction of the burden of surgery, combined with the availability
of various endoscopic closure devices. We aim to assess the technical and clinical
success and safety of endoscopic closure, in total, and for each endoscopic device
used. Also, to identify factors predicting surgery as a first line treatment, and
failure of endoscopic treatment.
Methods:
Medical literature (Cochrane library, EMBASE, MEDLINE) from 1966 till September 2016
was searched. A systematic review and meta-analysis were performed on studies reporting
technical and clinical success of endoscopic closure of acute iatrogenic perforations,
according to PRISMA guidelines.
Results:
764 studies were identified. 28 studies, in human, met our inclusion criteria and
were analysed. A total of 474 endoscopic closures were attempted in these studies.
The overall technical success rate was 93.1% (n = 451/474, 95% CI: 89.8%-96.4%), clinical
success was 89.7% (n = 431/474, 95% CI: 85.5%-93.9%), and complication rate was 1.3%
(n = 7/474, 95% CI: 0.3%-2.3%).
Factors predicting failure of endoscopic treatment and need for early surgical intervention
included large perforation size, leucocytosis, fever, severe abdominal pain, large
amount of peritoneal free air, necrotic or soft inflammatory margins, unfavourable
anatomical site, stool contamination, diffuse peritonitis and failure of endoscopic
closure.
Conclusions:
Our study suggests that endoscopic closure is a suitable treatment option for acute
iatrogenic gastrointestinal perforations. Several factors have been suggested as predictors
of need for surgery as a first line treatment.
