Iatrogenic perforation during endoscopy can rapidly lead to tension pneumoperitoneum, impairing visualisation and causing cardiopulmonary compromise. We describe a multicentre experience using percutaneous needle decompression to manage pneumoperitoneum during endoscopy. Across 60 cases over more than a decade, decompression was uniformly successful, without procedure-related adverse events and enabled completion of the index endoscopic procedure in 98% of patients. These findings support percutaneous needle decompression as a simple, safe and effective adjunct in the acute management of endoscopy-related perforation.
Advances in therapeutic endoscopy, including endoscopic submucosal dissection (ESD), peroral endoscopic myotomy (POEM) and endoscopic full-thickness resection (EFTR), have expanded minimally invasive treatment options for complex GI disease. However, these procedures carry an increased risk of iatrogenic perforation, with reported rates ranging from <0.01% for diagnostic colonoscopy to approximately 3% for therapeutic interventions such as ESD.
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