Endoscopic management of iatrogenic gastrointestinal perforations

Iatrogenic perforation (IP) is a rare but severe complication of endoscopy, and occurrences grow with the expansion of interventional endoscopy. Apart from symptoms and physical signs, CT scans provide an immediate and comprehensive diagnosis of IP and its severity. The general treatment is broad-spectrum antibiotics, intravenous nutrition, and close monitoring. Endoscopic treatments are considered as the first-line therapy. Endoclips are usually utilized for small perforations, while endoclips with endoloops and over the scope clip system are preferred for large ones. Covered self-expandable metal stents are effective for esophageal perforations. Fibrin glue and band ligation can be attempted, when the location of perforation is difficult for the clip placement. Close observation is required after the procedure. If endoscopic closure fails or deterioration occurs, surgical treatments should be requested.