Wimer Mata, MD, Gabriel Arevalo, MD, Victor Maciel, MD, Ibrahim Kayali, MD, Abraham Sayon, MD, Marius Calin, Kirpal Singh, MD, FACS, Maurice Arregui, MD, FACS. St. Vincent Hospital Indianapolis, IN
BACKGROUND: The indications for Endoscopic Ultrasound (EUS) for both diagnostic and therapeutic purposes have greatly increased and it is more widely available. Little has been published on the risk of perforation. The true incidence and risk factors for perforation are not well characterized in the literature. Factors outlined are the patient’s specific anatomic factors, older age and endosonographer’s experience. The often less mentioned and critical predisposing factor is the scope itself. Compared to standard endoscopes, the larger diameter, longer non-bending distal end and the oblique view of the instrument may be factors that influence the perforation rate. The aim of this study is to examine the rate of perforation with the radial echo-endoscope (Olympus GF UE 160- AL5) since its introduction to our gastrointestinal and minimally invasive surgery department in 2010. This is compared to the perforation rate with the older version of the radial echo-endoscope (Olympus GF UM 160) and the older and newer linear echoendoscope.
METHODS: EUS cases from 2002 to Aug 2014 of 3 endoscopists with more than two decades of combined experiences were retrospectively reviewed. A total of 807 EUS cases were performed: 543 cases with the old scopes (GF UCT 140ALS linear: 292 and GF-UM160 radial: 251 cases) from 2002 to 2009 and 264 cases with the new scopes (GF UE 160-AL5 radial: 70 and GF UCT 180 linear: 193) since 2010.
RESULTS: Two duodenal perforations during intubation of the duodenal bulb occurred. Overall perforation rate since 2002 was 0.247% and 0.76% since 2010 when the GF UE 160-AL 5 radial echo-endoscope was introduced. No perforations were encountered with the other three scope models. Duodenal intubation with the old or new radial scope were identified (n=126); 101 for the old radial scope and 25 for the new radial scope. Between the two groups, the calculated relative risk of perforation for the new radial scope was 20.38 with 95% CI [1.00 to 411.88], z score 1.966, p= 0.049 and the number needed to harm (NNH) 10.94 with 95% CI [6.518 to 33.965]. No anatomic alteration or luminal narrowing were identified in the patients who suffered the injury. Both duodenal perforations underwent laparoscopic modified graham patch.
CONCLUSION: From our experience, the radial echo-endoscope (Olympus GF UE 160-AL5) is associated with increased risk of perforation. It is possible that the distal tip shape, rigidity, length (at least 4 cm) and optical arrangement make intubation more traumatic at angulations.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 77496
Program Number: P345
Presentation Session: Poster (Non CME)
Presentation Type: Poster