Korean J Anesthesiol.  2017 Oct;70(5):555-560. 10.4097/kjae.2017.70.5.555.

The safety of endoscopic esophageal procedures under general anesthesia

• Kim GE
• Kim DK
• Choi JW
• Chung IS
• Jung DW

• KMID: 2395610
• DOI: http://doi.org/10.4097/kjae.2017.70.5.555

Abstract

BACKGROUND
With the increasing demand for general anesthesia for endoscopic esophageal procedures, anesthesiologists should understand the clinical characteristics of post-procedural complications (PPCs).
METHODS
We retrospectively investigated the incidence of and risk factors associated with PPCs of endoscopic esophageal procedures performed under general anesthesia from July 2013 to November 2016. The final analysis included 129 patients; 114 who underwent esophageal endoscopic dissection for esophageal tumors and 15 cases of peroral endoscopic myotomy for achalasia. Frank perforation during the procedure was defined as an endoscopically recognizable or clinically detected perforation during the procedures. A multivariable logistic regression analysis was conducted to identify independent risk factors for PPCs.
RESULTS
The overall incidence of PPCs was 19.4% (25/129). All of the PPCs were managed successfully with conservative measures. The most common PPC was symptomatic, radiologically documented atelectasis (11/25, 44.0%), followed by esophageal perforation-related PPCs (symptomatic pneumomediastinum or pneumoperitoneum; 9/25, 36.0%). In the multivariable analysis, frank perforation during the procedure was the only independent risk factor for PPCs (odds ratio, 8.470, 95% CI, 2.051-34.974, P = 0.003). Although frank perforation during the procedure occurred in 13 patients, 38.5% (5/13) of them did not develop any clinical sequelae after their procedures. Compared with patients without PPCs, patients who developed PPCs took longer to their first oral intake and had prolonged hospital stays (P = 0.047 and 0.026, respectively).
CONCLUSIONS
Iatrogenic perforation during endoscopic esophageal procedures under general anesthesia was the only independent risk factor for PPCs; therefore, proactive measures and close follow-up are necessary.

Keyword

Complications; Esophagus; Gastrointestinal endoscopy; General anesthesia

MeSH Terms

Anesthesia, General*
Endoscopy, Gastrointestinal
Esophageal Achalasia
Esophagus
Follow-Up Studies
Humans
Incidence
Length of Stay
Logistic Models
Mediastinal Emphysema
Pneumoperitoneum
Pulmonary Atelectasis
Retrospective Studies
Risk Factors