Gastroenterological Endoscopy. Группа авторов
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10 Endoscopic Complications
Daniel Blero and Jacques Devière
10.1 Introduction
An endoscopic complication can be defined as an adverse event that requires a deviation from the initial plan for diagnosis and/or treatment, and this adverse event can be qualified as severe when it prolongs hospitalization and/or results in an unscheduled hospital admission.1 The frequency of endoscopic complications is likely to increase in proportion to the indications and complexity of therapeutic procedures. The best way to prevent complication is to carefully analyze procedural indications and avoid unnecessary invasive examinations. Gastrointestinal (GI) endoscopy is a discipline evolving quickly within a multidisciplinary environment with paradigm changes such as the development of alternative, noninvasive diagnostic techniques, for example, magnetic resonance cholangiopancreatography (MRCP), which has entirely replaced diagnostic endoscopic retrograde cholangiopancreatography (ERCP) for imaging the biliopancreatic tract. With an increasing complexity of endoscopic procedures, the need for extensive knowledge of techniques and accessories has become paramount, and it is now clear that many of these procedures must be concentrated in specialized referral centers. Acquiring and maintaining experience in a multidisciplinary environment is essential to select the best procedure for a specific indication and to consequently reduce the risk of adverse events. Now that therapeutic endoscopy offers even more alternatives to open surgery, it is also important to disseminate information about the outcomes of these procedures in order to avoid inappropriate therapeutic approaches to manage known or suspected complications. For example, postprocedural management following submucosal and transmural endotherapy may result in imaging findings of incidental free air that may be inappropriately managed with aggressive surgery.2
Preprocedural patient education and informed consent (see Chapter 3) are paramount. Standardization of treatment, organization of the therapeutic endoscopy team and its training, and adherence to guidelines are also essential in order to minimize, prevent, and adequately manage adverse events. The most frequent complications of diagnostic and therapeutic endoscopy are reviewed in this chapter. Different modalities of medical, endoscopic, and surgical management are also considered.