CLINICAL PROFILE, RISK FACTORS AND OUTCOME OF PATIENTS WITH IATROGENIC PERFORATION DURING ENDOSCOPIC PROCEDURES AT THE UNIVERSITY OF THE PHILIPPINES- PHILIPPINE GENERAL HOSPITAL FROM JANUARY 2012 TO JANUARY 2016
1 Fellow, Gastroenterology, University of the Philippines, Philippine General Hospital 2 Consultant, Gastroenterology, University of the Philippines, Philippine General Hospital
Significance: Endoscopic procedures are commonly performed. They are relatively safe and carry low risk of adverse events. In the advent of advanced therapeutic endoscopy, a number of elderly patients and those patients with significant comorbidities are subjected to these procedures owing to the fact that these patients are at high risk from surgery. Patients undergoing therapeutic endoscopy are subjected to the same complications as; however, the extent of complications is greater. Identifying the risks for developing complications may lead to an alternative to endoscopic procedure or hypervigilance during and after the procedure.
Methodology: All adult patients diagnosed with iatrogenic perforation during endoscopic procedure at the Philippine General Hospital from January 2012 to January 2016 were included. Baseline characteristics, indication for the procedure, experience of the endoscopist, presence of endoscopic therapy, management and outcome were determined through review of medical records. Univariate and multivariate regression analysis were used to identify risk factors.
Results: Rate of occurrence of iatrogenic perforation during endoscopic procedure was 0.0006%. Age, gender, type of procedure and performance of any intervention did not appear to increase the risk of iatrogenic perforation. Presence of comorbidities and limited experience of the endoscopist, although, not statistically significant, appeared to increase the risk of perforation.
Conclusion: The rate of occurrence of iatrogenic perforation is low. Presence of comorbidities and limited experience of the endoscopist, though not statistically significant, appeared to increase the risk of iatrogenic perforation. Hypervigilance and close monitoring of patients with multiple comorbidities and supervision of endoscopist with limited experience should be observed.