American Society For Gastrointestinal Endoscopy

Complications of upper GI endoscopy

CARDIOPULMONARY COMPLICATIONS/ COMPLICATIONS RELATED TO SEDATION Cardiopulmonary complications related to sedation and analgesia are the most common type of complication seen with diagnostic endoscopy, accounting for up to 46% of those reported in the above-mentioned ASGE survey were related to sedation.1,2 This approximates a more recently reported proportion of 40% as published in 1991 by ASGE in collaboration with the Food and Drug Administration.3 These complications range from minor changes in vital signs to myocardial infarctions, respiratory depression, and shock/hypotension.2 Additionally, with the introduction of pulse oximetry, a greater number of nonclinically relevant events have been reported. It is estimated that oxygen desaturation may occur in up to 70% of patients undergoing various endoscopic examinations; more severe desaturation occurs less commonly.4,5 Factors leading to oxygen desaturation include difficulty with intubation, which may be related to the size of the endoscope. Patient factors include age and history of cardiovascular/pulmonary disease. Complications may arise related to the procedure itself, such as vasovagal reflex secondary to the intubation process and/or to overinsufflation of air. Judicious use of conscious sedation with appropriate monitoring equipment may help control the rate and severity of complications. The reader is referred to the ASGE documents regarding the appropriate use of conscious sedation and appropriate resuscitation equipment that should be maintained in an endoscopy lab.6-10 Sedation-related complications are generally identified during the procedure. Appropriate management includes basic life support if necessary. Proper management requires the presence of resuscitation medications, including reversal agents and equipment in all areas where endoscopy is performed. INFECTIOUS COMPLICATIONS Infectious complications related to diagnostic endoscopy result either from the procedure itself or from the use of contaminated equipment. Transient bacteremia may occur during a diagnostic endoscopic procedure and is found more often for therapeutic procedures.11-13 The incidence is relatively low and the rate of bacterial endocarditis or other complications in patients
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This is one of a series of statements discussing the utilization of gastrointestinal endoscopy in common clinical situations. The Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy prepared this text. In preparing this guideline, a MEDLINE literature search was performed, and additional references were obtained from the bibliographies of the identified articles and from recommendations of expert consultants. When little or no data exist from well-designed prospective trials, emphasis is given to results from large series and reports from recognized experts. Guidelines for appropriate utilization of endoscopy are based on a critical review of the available data and expert consensus. Further controlled clinical studies are needed to clarify aspects of this statement, and revision may be necessary as new data appear. Clinical consideration may justify a course of action at variance to these recommendations. Upper GI endoscopy is a very commonly performed procedure used as a diagnostic tool to evaluate patients with a wide range of problems and complaints. Complications related to diagnostic evaluations are rare. Based on a 1974 survey conducted by the American Society for Gastrointestinal Endoscopy, it was estimated that the overall complication rate based on over 200,000 esophagogastroduodenoscopy (EGD) examinations was 0.13% and carried an associated mortality of 0.004%.1 More current data for complication rates, specifically looking at diagnostic endoscopic examinations, are relatively understudied and prospective multicenter analyses have not been conducted in a systematic fashion. With the introduction of large multicenter databases, such as the CORI (Clinical Outcomes Research Initiative) project, better estimates of complications should be available in the future. However, although more accurate data may be obtained for immediate postprocedure complications, late complications may still be underestimated because of under-reporting. Rates of complications are critically dependent on the method of data collection (prospective/retrospective), definition of complication, and duration of follow-up. Major complications related to diagnostic procedures can be broken down into cardiopulmonary complications, complications related to sedation, infectious complications, perforation, and bleeding.
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not at risk for endocarditis (e.g., normal cardiac valves) is extremely low and estimated to be 1 in 5 to 10 million.14 The reader is referred to the ASGE document regarding the use of antibiotic prophylaxis for those patients who are at risk for endocarditis because of valvular abnormalities.15 Uncommon complications include retropharyngeal and retroesophageal abscesses in patients who have had difficult intubations.16,17 This may be related to retropharyngeal trauma and/or nonclinically apparent perforations. Issues related to contaminated equipment have been reviewed in the ASGE documents entitled Infection Control During Gastrointestinal Endoscopy; Guidelines for Clinical Application and Transmission.18,19 The reader is referred to these documents, for a discussion of appropriate cleaning procedures to prevent such contamination. PERFORATION Perforation of the upper GI tract related to diagnostic endoscopy is relatively low. In the above-mentioned 1974 ASGE survey, the perforation rate was 0.03% and with a mortality rate of 0.001%.1 Predisposing factors to perforations include the presence of anterior cervical osteophytes, Zenkers diverticulum, esophageal strictures, and malignancies.20-22 Although uncommon, perforations of the esophagus are associated with a relatively high mortality rate that approximates 25%.20 Pain is the most common and reproducible symptom related to perforation.20-23 Fever, crepitance, chest pain, pleuritic chest pain, leukocytosis, and pleural effusion may also be present. Perforations with associated air dissection may be diagnosed by plain radiograph of the neck and/or chest. If a perforation is suspected, this may be localized by use of contrast media. Water-soluble contrast is usually used initially. If a site of perforation cannot be determined, barium or CT scan may be used in a repeat examination. A negative study does not rule out a perforation, however.55 The approach to a patient with a perforation depends on the state of health of the individual, the site of the perforation, and the overall prognosis. In selected patients, early recognition may allow medical management with nasogastric suction, intravenous antibiotics, and parenteral hyperalimentation. Perforations related to endoscopy are best approached in cooperation with surgical colleagues. Surgical management is required for larger perforations when the pleural space is involved and for failure to respond to medical management. BLEEDING Significant bleeding is a rare complication of diagnostic upper endoscopy. Bleeding may be more likeVOLUME 55, NO. 7, 2002

ly in individuals with thrombocytopenia and/or coagulopathy.1 However, diagnostic upper endoscopy appears to be safe in patients with platelet counts as low as 20,000.1 Biopsies should be performed with caution below this level and platelet transfusions should be considered.1,6,7 Mallory-Weiss tears occur in <0.1% of diagnostic endoscopies and are usually not associated with significant bleeding. COMPLICATIONS OF UPPER GASTROINTESTINAL DILATION Determining the exact incidence of complications is difficult due to the low frequency and a lack of large studies comparing various methods of dilation. The most commonly observed complications of dilation of strictures are perforation, pain, hemorrhage, and bacteremia/sepsis. BENIGN PEPTIC ESOPHAGEAL STRICTURES In the 1974 survey of members of the American Society for Gastrointestinal Endoscopy the complication rate for dilation of the esophagus with mercury filled dilators was 0.4%. The most common complication in the group using mercury-filled dilators was bleeding. Most centers currently use either wire-guided, polyvinyl dilators (e.g., Savary-Gilliard) or balloon dilators. In comparative trials, there is no evidence that push dilators result in a higher rate of perforations when dilating benign esophageal strictures.26-30 In a recent article comparing various dilating systems, all perforations occurred with blind passage of Maloney dilators through complex strictures.30 There were no perforations when using balloon dilators or wire-guided Savary-type dilators. Blind passage of mercury-filled dilators or the use of metal olives may be associated with higher rates of perforation. Severe pain, bleeding, and bacteremia (including endocarditis or CNS infection) are other complications associated with esophageal dilation. Caustic strictures may be at greater risk of perforation due to the greater length and luminal compromise that are characteristic for these lesions.32 In a 25-year review of dilating caustic esophageal strictures, perforation was noted to occur in 17% of patients.33 ACHALASIA Pneumatic dilation of achalasia may be associated with a lower risk of complications when a graded dilation technique with low-compliance balloons is used. It is suggested to start dilation with a 30-mm balloon. Nonresponders should then undergo dilaGASTROINTESTINAL ENDOSCOPY 785

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tion with a 35-mm balloon and subsequently a 40mm balloon if needed.46 Avoiding inflation pressures greater than 11 psi may be associated with fewer complications.45 Prevention of dilation-related perforation may be possible by limiting dilation to less than 15-mm diameter. Two studies describing perforation rates of 4 and 6.7% were associated with dilation to greater than 15 mm.48,49 MALIGNANT ESOPHAGEAL STRICTURES The rate of perforation for dilating malignant esophageal strictures is higher than for benign strictures. The literature defines a rate of approximately 10% based on several studies.38-41 Two studies evaluating the treatment of esophageal strictures occurring after radiation treatment of esophageal cancer demonstrated a perforation rate of 2% to 6.5% per person.42,43 Dilation of a radiation stricture was not associated with a higher rate of perforation when compared with dilation of a malignant stricture that did not receive radiation.43 GASTRIC OUTLET OBSTRUCTION Studies report success with balloon dilation with a low complication rate. The rate of perforation varies from 0% to 6.7%.48-53 It appears as though perforations occur with attempts to dilate the gastric outlet to greater than 15-mm diameter. There is no evidence at present that the use of dilating balloons is associated with a lower rate of complications as compared with wire-guided, pushtype dilators.54 PEG COMPLICATIONS Minor complications associated with PEG placement occur in 13% to 43% of patients59-61 and include tube occlusion, maceration from leakage of gastric contents around the tube, and peristomal pain. Major complications, reported in 0.4% to 8.4% of procedures58,59,61-63 include infection, bleeding, perforation, ileus, injury of internal organs, tumor seeding, and death. Procedure-related mortality has been reported to range from 0% to 2%,59,61,64,65 with 30-day mortality in the range of 6.7% to 26%, often related to patient comorbidities.59-61,64-67 Infectious complications of PEG include wound infections, abscess, peritonitis, necrotizing fasciitis, and aspiration pneumonia. Peristomal wound infections occur at the site of PEG insertion through the abdominal wall in up to 41% of patients.60,62,68,69 However, use of antibiotic prophylaxis has been demonstrated to significantly reduce the risk of peristomal infections60,69-72 and is cost-effective.73 Several authors have reported cases of necrotizing
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fasciitis,74-77 which has been theorized to be related to failure to make the abdominal incision large enough to allow for appropriate wound drainage.75 Risk factors for necrotizing fasciitis include diabetes mellitus, atherosclerosis, alcoholism, malnutrition, immunosuppression, and older age.74 Signs of necrotizing fasciitis include high fevers, cellulitis, skin edema, and subcutaneous emphysema, though a high index of suspicion is often required for making the diagnosis.76 Treatment includes surgical debridement and antibiotics. Despite these measures, mortality ranges from 30% to 70%.74-76 Patients may develop aspiration pneumonia at the time of PEG placement because neurologic sequelae of stroke and dysphagia are common indications for a PEG.59,66 Whether these patients aspirate during the procedure itself, or aspirate their own secretions or feeds, is difficult to ascertain. Pneumoperitoneum is typically a benign occurrence, which has been reported in up to 38% of patients undergoing uncomplicated PEG.78-80 Bleeding can result from injury to gastric or abdominal wall vessels.59 Gastric tears may occur during PEG placement.59,66 Because PEG placement involves the essentially blind placement of a needle through the abdominal wall and into the stomach, injury to internal organs, such as the liver and colon,81-83 can occur. Numerous authors have reported cologastrocutaneous fistulae.81-83,85-92 These fistulae can remain silent until the original PEG tube is exchanged for a replacement tube. In the chronic setting, prompt removal of the tube has been recommended as the fistula is reported to heal within hours.93 Optimal management of colonic perforation in the acute setting is poorly studied, though surgery should be considered in patients with clinical evidence of perforation or severely malnourished patients who are at risk for poor wound healing.81 Feeding tubes may also migrate and become impacted in the abdominal wall.94-96 This buried bumper syndrome is believed to result from excessive traction on the internal PEG bolster. Ischemic necrosis of the gastric epithelium occurs, with resultant erosion of the internal bolster through the gastric wall.94 Signs include resistance to flow through the tube and immobility of the tube. Endoscopically, the PEG may not be visible. Treatment involves removal of the tube and placement of a new tube.61 Some have advocated avoiding direct contact between the internal bolster and the gastric mucosa.97 Although it is important to maintain apposition of the gastric wall to the abdominal wall until the fistula tract is mature, the external bumper can be subsequently loosened in an attempt to avoid this complication.
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Many PEGs are placed for dysphagia secondary to head and neck cancers. Several reports raise concern of potential facilitation of metastases as some patients have metastases develop at the PEG insertion site.98-101 It is unclear whether this results from hematogenous spread or through transport of exfoliated tumor cells by the feeding tube. One final complication to note is accidental tube dislodgement. Use of an abdominal binder after placement may prevent accidental PEG removal.59 With early dislodgement, peritonitis may develop because there is not a mature fistulous tract. If a mature tract is present (greater than 1 month), then a suitable replacement tube should be inserted as soon as possible. Foley catheters are readily available and effective. However, care must be taken to prevent duodenal obstruction by the balloon. Therefore, an external bolster should be improvised.102 In patients in whom it is unclear whether or not the track is mature, confirmation of correct replacement tube location should be confirmed with contrast injection and fluoroscopy. Although placement of a PEG/JET has the same complications as PEG, these tubes may be more prone to clogging (4%-18%), unintentional removal (11%-18%), and tube migration (6%).103,104 Wolfson et al.105 have reported tube dysfunction in 53% of 75 patients during 275 days of follow-up. Nevertheless, the reduced risk of aspiration (estimated relative risk reduction of 91% in a single observational study)61 appears to justify use in carefully selected patients. COMPLICATIONS OF ENDOSCOPIC FOREIGN BODY RETRIEVAL Complications directly attributable to the endoscopic removal of foreign bodies are very rare, and when complications occur it is difficult to determine whether the cause was the endoscopy or the foreign object itself.113 Nonetheless, endoscopic foreign body retrieval and meat disimpaction have been associated with complications in up to 8% of cases.114,115 Additional techniques may decrease the risks associated with foreign body removal. The risk of aspiration or mucosal injury may be reduced by the use of an esophageal overtube.112,116 Esophageal overtubes have been associated with bleeding and perforation, and these risks should be weighed against the benefits of overtube use in each case.117 Mucosal injury from the removal of sharp objects can be limited by removing the object such that the point is trailing and by using an overtube.116,117 A latex hood fitted over the end of the endoscope may also be beneficial in protecting the mucosa from laceration.168 Blind passage of bougies or use of papain (meat tenderizer) to
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dislodge meat impaction should be avoided due to the significant risk of perforation.1 Endoscopically, it may be possible to gently push an esophageal food bolus into the stomach, particularly if the endoscope can be maneuvered around the bolus under direct vision.117 To assess for mucosal lacerations, bleeding, and the presence of underlying pathology (present in most esophageal food impactions), reinsertion of the endoscope after foreign body clearance should be performed.116 Most mucosal injuries can be treated conservatively and bleeding that is not self-limited can be treated with standard endoscopic techniques. Failure of endoscopic removal occurs in less than 5% of cases and surgery should be considered.114 COMPLICATIONS IN THE TREATMENT OF ESOPHAGEAL MALIGNANCIES Injection of sclerosants such as ethanol directly into the tumor to achieve tumor necrosis may damage normal tissues because of tracking of the sclerosant along tissue planes leading to perforation and the development of fistulae.122 Thermal methods to apply heat energy directly to the tumor include bipolar cautery, laser, and argon plasma coagulation.123-125 Major complications include perforation and the development of fistulae in up to 10%.122,124,125 Minor complications include pain, edema, and treatment-induced strictures.123 Photodynamic therapy (PDT) complications are similar to the other ablative techniques (bleeding, perforation, fistulae, strictures) but also include sun photosensitivity.124,126,127 Dysphagia may initially worsen after PDT requiring hospital admission for intravenous fluids, and PDT has been associated with atrial fibrillation and the development of pleural effusions.124,126 Esophageal endoprostheses made of plastic or a self-expanding metal material have been used to reestablish luminal patency. The plastic stents have been replaced by the self-expanding metal stents due to the significantly lower complication rates.128 Postdeployment complications occur in 20% to 40% and include stent migration, hemorrhage, food impaction, and tumor ingrowth or overgrowth.121,129 Death is seen in 3% because of exsanguinating hemorrhage, aspiration, and perforation.130 Chest pain after insertion occurs in approximately 20%.131,132 Pretreatment with chemoradiotherapy has been reported to increase the incidence of complications by some authors133 but not others.134 An antireflux stent is now available that may decrease reflux symptoms, but whether it will decrease the risk of aspiration is unknown.135 Endoscopic techniques and patient education may be useful in avoiding or managing complicaGASTROINTESTINAL ENDOSCOPY 787

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tions. Blind bougienage of malignant strictures should be avoided.120 Expandable stents are preferable to nonexpandable plastic stents.128 Stent occlusion caused by tumor ingrowth can be avoided by use of a covered stent, and overgrowth treated with thermal ablative techniques or insertion of another stent.130,136 Laser, APC, or PDT-induced strictures can be treated with dilation or placement of a stent.123,125,126 Patients with stents that cross the GE junction should keep the head of the bed raised to 30 degrees and avoid eating for several hours before retiring. Patients undergoing PDT are at risk for phototoxicity and need to use sunscreen and avoid direct sunlight exposure for up to 6 weeks.121 COMPLICATIONS OF ENDOSCOPIC HEMOSTASIS: ENDOSCOPIC VARICEAL SCLEROTHERAPY Treatment of esophageal varices by sclerotherapy (EVS) is acknowledged to have several potential complications. These may be local (esophageal) and/or systemic. The overall rate of complications is difficult to ascertain because endoscopic series have varied by technique, sclerosant, and follow-up.137 The overall complication rate has been estimated to be between 35% to 78%, with a mortality rate of 1% to 5%.138,139 It has been estimated that ulcerations secondary to EVS occur in 50% to 78%.140,141 Significant bleeding can occur in 6% of these patients.141 Most of these ulcers are asymptomatic but can be diagnosed by endoscopy 4 to 7 days after an EVS session. Ulcer formation does not appear to correlate with the choice of sclerosant or injection technique. They may occur more often if sclerotherapy sessions are conducted in closely timed (<1 week) sessions.142,143 Therefore elective EVS sessions for variceal eradication should be planned on a weekly or greater interval. Unfortunately, it does not appear that antisecretory therapy (H2RAs, PPIs) or sucralfate prevent ulcer formation.144-147 Omeprazole may be effective in healing these ulcerations.148,149 Esophageal perforation may occur acutely in 2% to 5% of patients shortly after EVS.150 Delayed perforation is known to occur, but the incidence is unknown. Early diagnosis may be difficult because 25% to 50% of patients undergoing EVS have chest pain develop. However, this symptom usually abates within 24 to 48 hours.151 Esophageal stricture formation can occur weeks to months after EVS sessions in 2% to 20% of patients.152,153 This can be diagnosed by upper gastrointestinal series and/or endoscopy. When EVS is performed with paravariceal injection with polidocanol, stricture formation appears to correlate with
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the number of EVS sessions and the amount of sclerosant used.154 There are no data on other sclerosant use and technique affecting stricture formation. Treatment is similar to that of benign peptic strictures, with endoscopic dilation. Up to 5% of patients may experience aspiration pneumonia after EVS.153-156 This complication usually occurs during emergent sessions for variceal bleeding. The endoscopist should have a low threshold for airway protection (endotracheal intubation) in patients with altered mental status and/or significant hemetemesis. Other commonly reported complications related to EVS include pleural effusion and bacterial peritonitis. ENDOSCOPIC BAND LIGATION Endoscopic band ligation (EBL) has emerged as the preferred endoscopic intervention for the treatment of esophageal varices. This is in part because of its favorable side effect profile as compared with EVS. Esophageal ulcer formation is seen in 5% to 15% and there is a lower tendency for ulcer-related bleeding than EVS.153,155-158 Perforation has been reported in 0.7% of 284 patients in 5 randomized trials.153,155-157 These perforations were associated with use of an overtube for facilitating multiple endoscope passes. Overtube use for this purpose is now discouraged and with multibanding devices, generally unnecessary. However, passing the overtube over an esophageal bougie may decrease the rate of perforation. Esophageal stricture formation as a consequence of EBL is rare. No strictures were reported in 8 randomized trials.153,155-158 Only single cases have been presented in the literature.159,160 The true incidence of this complication is unknown. Aspiration pneumonia was seen in 1% of patients among 7 randomized trials.153,155-158 These 7 trials showed a bacterial peritonitis rate of 4%. The overall mortality attributable to the acute complications of ligation in prospective trials is 1%. ENDOSCOPIC NONVARICEAL HEMOSTASIS Endoscopic hemostasis of nonvariceal bleeding is most often achieved by injection and/or thermal electrocoagulation. Injection of sclerosants (traditionally used for sclerotherapy) may lead to tissue necrosis and rarely perforation.161 The most commonly used injection agent is epinephrine. No perforations have been reported in patients treated with epinephrine injection for bleeding ulcers in randomized trials. However, tissue necrosis and ulceration may occur with decreased arterial blood flow to the injected site.162,163 Endoscopic thermal hemostasis may be achieved by bipolar or multipolar electrocoagulation (MPEC),
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heater probes, or laser. Randomized controlled trials using MPEC have reported rates of perforation between 0% and 2%.164,165 Induction of bleeding is a relatively common complication of electrocoagulation, occurring in up to 5% of cases.164,165 Usually this can be controlled during the endoscopic procedure. Hemostasis using a heater probe has similar rates of perforation as MPEC. However, repeat treatment when performed within 24 to 48 hours of the initial session is associated with up to 4% risk of perforation.166 Recurrent bleeding rates are similar to that of MPEC. SUMMARY Endoscopic complications will inevitably occur if an endoscopist does many procedures. Knowledge of potential complications and their expected frequency can lead to improved risk-benefit analysis by physicians and patients as well as true informed consent by patients. Early recognition of complications and prompt intervention may minimize patient morbidity.
REFERENCES
1. Silvis SE, Nebel O, Rogers G, Sugawa C, Mandelstam P. Endoscopic complications. Results of the 1974 American Society for Gastrointestinal Endoscopy Survey. JAMA 1976;235:928. 2. Benjamin SB. Complications of conscious sedation. Gastrointest Endosc Clin N Amer 1996;6:2. 3. Arrowsmith JB, Gerstman BB, Fleischer DE, Benjamin SB. Results from the American Society for Gastrointestinal Endoscopy/U.S. Food and Drug Administration collaborative study on complication rates and drug use during gastrointestinal endoscopy. Gastrointest Endosc 1991;37:421. 4. Barkin JS, Krieger B, Blinder M, Bosch-Blinder L, Goldberg RI, Phillips RS. Oxygen desaturation and changes in breathing pattern in patients undergoing colonoscopy and gastroscopy. Gastrointest Endosc 1989;35:526. 5. Dark DS, Campbell DR, Wesselius LJ. Arterial oxygen desaturation during gastrointestinal endoscopy. Am J Gastroenterol 1990;85:1317. 6. ASGE. Modifications in endoscopic practice for the elderly. Gastrointest Endosc 2000;52:849-51. 7. Brown, RD, Goldstein JL. Quality assurance in the endoscopy unit: an emphasis on outcomes. Gastrointest Endosc Clin North Am 1999;9:4. 8. ASGE. Sedation and monitoring of patients undergoing gastrointestinal endoscopic procedures. Gastrointest Endosc 1995;42:626-9. 9. ASGE. Establishment of gastrointestinal endoscopy areas. Gastrointest Endosc 1999;50:910-12. 10. ASGE. Monitoring equipment for endoscopy. Gastrointest Endosc 1995;42:615-7. 11. Baltch AL, Buhac I, Agrawal A, OConnor P, Bram M, Malatino E. Bacteremia after upper gastrointestinal endoscopy. Arch Intern Med 1977;137:594. 12. Botoman VA, Surawicz CM. Bacteremia with gastrointestinal endoscopic procedures. Gastrointest Endosc 1986;32: 342. VOLUME 55, NO. 7, 2002

13. Norfleet RG, Mitchell PD, Nulholland DD, Philo J. Does bacteremia follow upper gastrointestinal endoscopy? Am J Gastroenterol 1981;76:420. 14. Mogadam M, Malhotra SK, Jackson RA. Pre-endoscopic antibiotics for the prevention of bacterial endocarditis: do we use them appropriately? Am J Gastroenterol 1994;89:832. 15. ASGE. Antibiotic prophylaxis for gastrointestinal endoscopy. Gastrointest Endosc 1995;42:630-5. 16. Carmody TJ, Wergowske GL. Retropharyngeal abscess and hematoma in an elderly woman following esophagoscopy and endotracheal intubation. J Am Geriatr Soc 1983;31:499. 17. Enat R, Levitan R. Retroesophageal abscess twenty-five days after esophagoscopy. An unusual complication of endoscopy. Gastrointest Endosc 1972;18:167. 18. ASGE. Infection control during gastrointestinal endoscopy. Gastrointest Endosc 1999;49:836-41. 19. ASGE. Transmission of infection by gastrointestinal endoscopy. Gastrointest Endosc 2001;54:824-8. 20. Pettersson G, Larsson S, Gatzinsky P, Sudow G. Differentiated treatment of intrathoracic oesophageal perforations. Scand J Thorac Cardiovasc Surg 1981;15:321. 21. Schulze S, Pedersen VM, Hoier-Madsen K. Iatrogenic perforation of the esophagus. Acta Chirurgica Scandinavia 1982;148:679. 22. Wychulis AR, Fontana RS, Payne WAS. Instrumental perforation of the esophagus. Dis Chest 1969;55:184. 23. Larsen K, Jensen BS, Axelsen F. Perforation and rupture of the esophagus. Scand J Thorac Cardiovasc Surg 1983;17:311. 24. Lanza FL, Graham DY. Bougienage is effective therapy for most benign esophageal strictures. JAMA 1978;240:844-7. 25. Patterson DJ, Graham DY, Smith L, Schwartz JT, Alpert E, Lanza FL, et al. Natural history of benign esophageal stricture treated by dilation. Gastroenterology 1983;85:346-50. 26. Cox JG, Winter RK, Maslin SC, Jones R, Buckton GK, Hoare RC, et al. Balloon or bougie for dilatation of benign oesophageal stricture? An interim report of a randomized controlled trial. Gut 1988;29:1741-7. 27. Shemesh E, Czerniak A. Comparison between SavaryGilliard and balloon dilatation of benign esophageal strictures. World J Surg 1990;14:518-22. 28. Cox JGC, Winter RK, Maslin SC, Dakkak M, Jones R, Buckton GK, et al. Balloon or bougie for dilatation of benign esophageal stricture. Dig Dis Sci 1994;39:776-81. 29. Saeed ZA, Winchester CB, Ferro PS, Michaletz PA, Schwartz JT, Graham DY. Prospective randomized comparison of polyvinyl bougies and through-the-scope balloon for dilation of peptic strictures of the esophagus. Gastrointest Endosc 1995;41:189-95. 30. Hernandez LJ, Jacobson JW, Harris MS. Comparison among the perforation rates of Maloney, balloon and Savary dilation of esophageal strictures. Gastrointest Endosc 2000;51: 460-2. 31. Yamamoto H, Hughes RW, Schroeder KW, Viggiano TR, DiMagno EP. Treatment of benign esophageal stricture by Eder-Puestow or balloon dilators: a comparison between randomized and prospective nonrandomized trials. Mayo Clin Proc 1992;67:228-36. 32. Clouse RE. Complications of endoscopic gastrointestinal dilation techniques. Gastrointest Endosc Clin NA 1996;6: 323-41. 33. Karnak I, Tanyel FC, Buyukpamukcu N, Hicsonmez A. Esophageal perforations encountered during the dilation of caustic esophageal strictures. J Cardiovasc Surg 1998;39: 373-7. 34. Fregonese D, Di Faco G, Di Toma F. Balloon dilatation of GASTROINTESTINAL ENDOSCOPY 789

Author

Title

35.

36.

37.

38.

39.

40.

41.

42.

43.

44.

45.

46.

47.

48.

49.

50.

51.

52. 790

anastomotic intestinal stenoses: long term results. Endoscopy 1990;22:249-53. Ikeya T, Ohwada S, Ogawa T, Tanahashi Y, Takeyoshi I, Koyama T, et al. Endoscopic balloon dilation for benign esophageal anastomotic stricture: factors influencing its effectiveness. Hepatogastroenterology 1999;46:959-66. Honkoop P, Siersema PD, Tilanus HW, Stassen LPS, Hop WCJ, van Blankenstein M. Benign anastomotic strictures after transhiatal esophagectomy and cervical esophagogastrostomy: risk factors and management. J Thorac Cardiovasc Surg 1996;111:1141-8. Pereira-Lima JC, Ramires RP, Zamin I, Cassal AP, Marroni CA, Mattos AA. Endoscopic dilation of benign esophageal strictures: report on 1043 procedures. Am J Gastroenterol 1999;94:1497-501. Anderson PE, Cook A, Amery AH. A review of the practice of fiberoptic endoscopic dilatation of oesophageal stricture. Ann R Coll Surg Engl 1989;71:124-7. Neuhaus H, Hoffman W, Dittler HJ, Niedermeyer HP, Classen M. Implantation of self-expanding esophageal metal stents for palliation of malignant dysphagia. Endoscopy 1992;24:405-10. Newcomer MK, Brazer SR. Complications of upper gastrointestinal endoscopy and their management. Gastrointest Endosc Clin N Am 1994;4:551-70. Van Dam J, Rice TW, Catalano MF, Kirby T, Sivak MV Jr. High-grade malignant stricture is predictive of esophageal tumor stage. Risks of endosonographic evaluation. Cancer 1993;71:2910-17. Swaroop VS, Desai DC, Mohandas KM, Dhir V, Dave UR, Gulla RI, et al. Dilation of esophageal strictures induced by radiation therapy for cancer of the esophagus. Gastrointest Endosc 1994;40:311-5. Ng TM, Spencer GM, Sargeant IR, Thorpe SM, Brown SG. Management of strictures after radiotherapy for esophageal cancer. Gastrointest Endosc 1996;43:584-90. Eckardt VF, Kanzler G, Westermeier T. Complications and their impact after pneumatic dilation for achalasia: prospective long-term follow-up study. Gastrointest Endosc 1997; 45:349-53. Nair LA, Reynolds JC, Parkman HP, Ouyang Q, Strom BL, Rosato EF, et al. Complications during pneumatic dilation for achalasia or diffuse esophageal spasm: analysis of risk factors, early clinical characteristics, and outcome. Dig Dis Sci 1993;38:1893-904. Kadakia SC, Wong RKH. Graded pneumatic dilation using Rigiflex achalasia dilators in patients with primary esophageal achalasia. Am J Gastroenterol 1993;88:34-8. Molina EG, Stollman N, Grauer L, Reiner DK, Barkin JS. Conservative management of esophageal nontransmural tears after pneumatic dilation for achalasia. Am J Gastroenterol 1995;91:15-8. Kozarek RA, Botoman VA, Patterson DJ. Long-term followup in patients who have undergone balloon dilation for gastric outlet obstruction. Gastrointest Endosc 1990;36:558-61. DiSario JA, Fennerty MB, Tietze CC, Hutson WR, Burt RW. Endoscopic balloon dilation for ulcer-induced gastric outlet obstruction. Am J Gastroenterol 1994;89:868-71. Kuwada SK, Alexander GL. Long-term outcome of endoscopic dilation of nonmalignant pyloric stenosis. Gastrointest Endosc 1995;41:15-7. Misra SP, Dwivedi M. Long-term follow-up of patients undergoing balloon dilation for benign pyloric stenosis. Endoscopy 1996;28:552-4. Hewitt PM, Krige JEJ, Funnell IC, Wilson C, Bornman PC. GASTROINTESTINAL ENDOSCOPY

53.

54.

55.

56.

57.

58.

59.

60.

61.

62.

63.

64.

65.

66.

67.

68.

69.

Endoscopic balloon dilatation of peptic pyloroduodenal strictures. J Clin Gastroenterol 1999;28:33-5. Boylan JJ, Gradzka MI. Long-term results of endoscopic balloon dilatation for gastric outlet obstruction. Dig Dis Sci 1999;44:1883-6. Scolapio JS, Pasha TM, Gostout CJ, Mahoney DW, Zinsmeister AR, Ott BJ, et al. A randomized prospective study comparing rigid to balloon dilators for benign esophageal strictures and rings. Gastrointest Endosc 1999; 50:13-7. Sawyer R, Phillips C, Vakil N. Short- and long-term outcome of esophageal perforation. Gastrointest Endosc 1995;41: 130-4. Miller RE, Bossart PW, Tiszdnkel HI. Surgical management of complications of upper gastrointestinal endoscopy and esophageal dilation including laser therapy. Am Surg 1987;53:667-71. Gauderer MW, Ponsky JL, Izant RJ Jr. Gastrostomy without laparotomy: a percutaneous endoscopic technique. J Pediatr Surg 1980;15:872-5. Amann W, Mischinger HJ, Berger A, Rosanelli G, Schweiger W, Werkgartner G. Percutaneous endoscopic gastrostomy (PEG). 8 years of clinical experience in 232 patients. Surg Endosc 1997;11:741-4. Larson DE, Burton DD, Schroeder KW, DiMagno EP. Percutaneous endoscopic gastrostomy. Indications, success, complications, and mortality in 314 consecutive patients. Gastroenterology 1987;93:48-52. Akkersdijk WL, van Bergeijk JD, van Egmond T, Mulder CJ, van Berge Henegouwen GP, van der Werken C. Percutaneous endoscopic gastrostomy (PEG): comparison of push and pull methods and evaluation of antibiotic prophylaxis. Endoscopy 1995;27:313-6. Mathus-Vliegen LM, Koning H. Percutaneous endoscopic gastrostomy and gastrojejunostomy: a critical reappraisal of patient selection, tube function and the feasibility of nutritional support during extended follow-up. Gastrointest Endosc 1999;50:746-54. Foutch PG, Haynes WC, Bellapravalu S, Sanowski RA. Percutaneous endoscopic gastrostomy (PEG). A new procedure comes of age. J Clin Gastroenterol 1986;8:10-5. Rabeneck L, Wray NP, Petersen NJ. Long-term outcomes of patients receiving percutaneous endoscopic gastrostomy tubes. J Gen Int Med 1996;11:287-93. Wolfsen HC, Kozarek RA, Ball TJ, Patterson DJ, Botoman VA, Ryan JA. Long-term survival in patients undergoing percutaneous endoscopic gastrostomy and jejunostomy. Am J Gastroenterol 1990;85:1120-2. Hull MA, Rawlings J, Murray FE, Field J, McIntyre AS, Mahida YR, et al. Audit of outcome of long-term enteral nutrition by percutaneous endoscopic gastrostomy. Lancet 1993;341:869-72. Panos MZ, Reilly H, Moran A, Reilly T, Wallis PJ, Wears R, et al. Percutaneous endoscopic gastrostomy in a general hospital: prospective evaluation of indications, outcome, and randomised comparison of two tube designs. Gut 1994;35: 1551-6. Llaneza PP, Menendez AM, Roberts R, Dunn GD. Percutaneous endoscopic gastrostomy: clinical experience and follow-up. South Med J 1988;81:321-4. Jonas SK, Neimark S, Panwalker AP. Effect of antibiotic prophylaxis in percutaneous endoscopic gastrostomy. Am J Gastroenterol 1985;80:438-41. Jain NK, Larson DE, Schroeder KW, Burton DD, Cannon KP, Thompson RL, et al. Antibiotic prophylaxis for percutaVOLUME 55, NO. 7, 2002

Title

Author

70.

71.

72.

73.

74.

75.

76.

77.

78.

79.

80.

81.

82.

83.

84.

85.

86.

87.

88.

neous endoscopic gastrostomy. A prospective, randomized, double-blind clinical trial. Ann Int Med 1987;107:824-8. Gossner L, Keymling J, Hahn EG, Ell C. Antibiotic prophylaxis in percutaneous endoscopic gastrostomy (PEG): a prospective randomized clinical trial. Endoscopy 1999;31: 119-24. Preclik G, Grune S, Leser HG, Lebherz J, Heldwein W, Machka K, et al. Prospective, randomised, double blind trial of prophylaxis with single dose of co-amoxiclav before percutaneous endoscopic gastrostomy. BMJ 1999;319:881-4. Dormann AJ, Wigginghaus B, Risius H, Kleimann F, Kloppenborg A, Grunewald T, et al. A single dose of ceftriaxone administered 30 minutes before percutaneous endoscopic gastrostomy significantly reduces local and systemic infective complications. Am J Gastroenterol 1999;94:3220-4. Kulling D, Sonnenberg A, Fried M, Bauerfeind P. Cost analysis of antibiotic prophylaxis for PEG. Gastrointest Endosc 2000;51:152-6. Haas DW, Dharmaraja P, Morrison JG, Potts JR. Necrotizing fasciitis following percutaneous endoscopic gastrostomy. Gastrointest Endosc 1988;34:487-8. Greif JM, Ragland JJ, Ochsner MG, Riding R. Fatal necrotizing fasciitis complicating percutaneous endoscopic gastrostomy. Gastrointest Endosc 1986;32:292-4. Cave DR, Robinson WR, Brotschi EA. Necrotizing fasciitis following percutaneous endoscopic gastrostomy. Gastrointest Endosc 1986;32:294-6. Person JL, Brower RA. Necrotizing fasciitis/myositis following percutaneous endoscopic gastrostomy. Gastrointest Endosc 1986;32:309. Plumser AB, Gottfried EB, Clair MR. Pneumoperitoneum after percutaneous endoscopic gastrostomy. Am J Gastroenterol 1984;79:440-1. Stassen WN, McCullough AJ, Marshall JB, Eckhauser ML. Percutaneous endoscopic gastrostomy: another cause of benign pneumoperitoneum. Gastrointest Endosc 1984;30: 296-8. Gottfried EB, Plumser AB, Clair MR. Pneumoperitoneum following percutaneous endoscopic gastrostomy. A prospective study. Gastrointest Endosc 1986;32:397-9. Maccabee DL, Dominitz JA, Lee SW, Billingsley KG. Acute presentation of transverse colon injury following percutaneous endoscopic gastrostomy tube placement: case report and review of current management. Surg Endosc 2000;14: 296. van Gossum A, DesMarez B, Cremer M. A colo-cutaneousgastric fistula: a silent and unusual complication of percutaneous endoscopic gastrostomy. Endoscopy 1988;20:161. Minocha A, Rupp TH, Jaggers TL, Rahal PS. Silent colo-gastrocutaneous fistula as a complication of percutaneous endoscopic gastrostomy. Am J Gastroenterol 1994;89:2243-4. Foutch PG, Talbert GA, Waring JP, Sanowski RA. Percutaneous endoscopic gastrostomy in patients with prior abdominal surgery: virtues of the safe tract. Am J Gastroenterol 1988;83:147-50. Bui HD, Dang CV, Schlater T, Nghiem CH. A new complication of percutaneous endoscopic gastrostomy. Am J Gastroenterol 1988;83:448-51. Miller RE, Castlemain B, Lacqua FJ, Kotler DP. Percutaneous endoscopic gastrostomy. Results in 316 patients and review of literature. Surg Endosc 1989;3:186-90. Ponsky JL, Gauderer MW, Stellato TA, Aszodi A. Percutaneous approaches to enteral alimentation. Am J Surg 1985;149:102-5. Stefan MM, Holcomb GWd, Ross AJ. Cologastric fistula as a

89. 90.

91.

92.

93.

94.

95.

96.

97.

98.

99.

100.

101.

102. 103.

104.

105.

106.

107.

complication of percutaneous endoscopic gastrostomy. Jpn: J Parenteral Enteral Nutr 1989;13:554-6. Marion MT, Zweng TN, Strodel WE. One-stage gastrostomy button: an assessment. Endoscopy 1994;26:666-70. Saltzberg DM, Anand K, Juvan P, Joffe I. Colocutaneous fistula: an unusual complication of percutaneous endoscopic gastrostomy. Jpn: J Parenteral Enteral Nutr 1987;11:86-7. Murphy S, Pulliam TJ, Lindsay J. Delayed gastrocolic fistula following percutaneous endoscopic gastrostomy (PEG). J Am Geriatr Soc 1991;39:532-3. Fernandes ET, Hollabaugh R, Hixon SD, Whitington G. Late presentation of gastrocolic fistula after percutaneous gastrostomy. Gastrointest Endosc 1988;34:368-9. Gauderer MW, Stellato TA. Gastrostomies: evolution, techniques, indications, and complications. Curr Problems Surg 1986;23:657-719. Klein S, Heare BR, Soloway RD. The buried bumper syndrome: a complication of percutaneous endoscopic gastrostomy. Am J Gastroenterol 1990;85:448-51. Behrle KM, Dekovich AA, Ammon HV. Spontaneous tube extrusion following percutaneous endoscopic gastrostomy. Gastrointest Endosc 1989;35:56-8. Shallman RW, NorFleet RG, Hardache JM. Percutaneous endoscopic gastrostomy feeding tube migration and impaction in the abdominal wall. Gastrointest Endosc 1988;34:367-8. Foutch PG, Woods CA, Talbert GA, Sanowski RA. A critical analysis of the Sacks-Vine gastrostomy tube: a review of 120 consecutive procedures. Am J Gastroenterol 1988;83:812-5. Meurer MF, Kenady DE. Metastatic head and neck carcinoma in a percutaneous gastrostomy site. Head Neck 1993; 15:70-3. Preyer S, Thul P. Gastric metastasis of squamous cell carcinoma of the head and neck after percutaneous endoscopic gastrostomyreport of a case. Endoscopy 1989;21:295. Huang DT, Thomas G, Wilson WR. Stomal seeding by percutaneous endoscopic gastrostomy in patients with head and neck cancer. Arch OtolaryngolHead Neck Surg 1992; 118:658-9. Bushnell L, White TW, Hunter JG. Metastatic implantation of laryngeal carcinoma at a PEG exit site. Gastrointest Endosc 1991;37:480-2. Kirtley DW, Willis MJ, Thomas E. Reducing PEG wound problems. Gastrointest Endosc 1987;33:51-2. DeLegge MH, Duckworth PF Jr, McHenry L Jr, FoxxOrenstein A, Craig RM, Kirby DF. Percutaneous endoscopic gastrojejunostomy: a dual center safety and efficacy trial [published erratum appears in Jpn J Parenter Enteral Nutr 1995 Jul-Aug;19:329]. Jpn: J Parenteral Enteral Nutr 1995; 19:239-43. DeLegge MH, Patrick P, Gibbs R. Percutaneous endoscopic gastrojejunostomy with a tapered tip, nonweighted jejunal feeding tube: improved placement success. Am J Gastroenterol 1996;91:1130-4. Wolfsen HC, Kozarek RA, Ball TJ, Patterson DJ, Botoman VA. Tube dysfunction following percutaneous endoscopic gastrostomy and jejunostomy. Gastrointest Endosc 1990;36: 261-3. Henderson JM, Strodel WE, Gilinsky NH. Limitations of percutaneous endoscopic jejunostomy. Jpn: J Parenteral Enteral Nutr 1993;17:546-50. Shike M, Schroy P, Ritchie MA, Lightdale CJ, Morse R. Percutaneous endoscopic jejunostomy in cancer patients with previous gastric resection. Gastrointest Endosc 1987; 33:372-4. GASTROINTESTINAL ENDOSCOPY 791

VOLUME 55, NO. 7, 2002

Author

Title

108. Shike M, Berner YN, Gerdes H, Gerold FP, Bloch A, Sessions R, et al. Percutaneous endoscopic gastrostomy and jejunostomy for long-term feeding in patients with cancer of the head and neck. OtolaryngolHead Neck Surg 1989;101:549-54. 109. Shike M, Wallach C, Likier H. Direct percutaneous endoscopic jejunostomies. Gastrointest Endosc 1991;37:62-5. 110. Shike M, Latkany L, Gerdes H, Bloch AS. Direct percutaneous endoscopic jejunostomies for enteral feeding. Gastrointest Endosc 1996;44:536-40. 111. Rumalla A, Baron TH. Results of direct percutaneous endoscopic jejunostomy, an alternative method for providing jejunal feeding. Mayo Clinic Proceedings 2000;75:807-10. 112. ASGE. ASGE Guideline for the management of ingested foreign bodies. Gastrointest Endosc 1995;42:622-5. 113. Webb WA. Management of foreign bodies of the upper gastrointestinal tract: update. Gastrointest Endosc 1995;41:3951. 114. Vizcarrondo FJ, Brady PG, Nord HJ. Foreign bodies of the upper gastrointestinal tract. Gastrointest Endosc 1983;29: 208-10. 115. Berggreen PJ, Harrison ME, Sanowski RA, Ingebo K, Noland B, Zierer S. Techniques and complications of esophageal foreign body extraction in children and adults. Gastrointest Endosc 1993;39:626-30. 116. Ginsberg GG. Management of ingested foreign objects and food bolus impactions. Gastrointest Endosc 1995;41:33-8. 117. Carr-Locke DL, Al-Kawas FH, Branch MS, Byrne WJ, Edmundowicz SA, Jamidar PA, et al. Overtube use in gastrointestinal endoscopy. Gastrointest Endosc 1996;44:767-70. 118. Faigel DO, Fennerty MB. Miscellaneous diseases of the esophagus. In: Yamada T, editor. Textbook of gastroenterology. Philadelphia: Lippincott Williams & Wilkins; 1999. p. 1304-25. 119. Cooper GS, Blades EW. Indications, contraindications and complications of upper gastrointestinal endoscopy. In: Sivak MV Jr, editor. Gastroenterologic endoscopy. Philadelphia: WB Saunders; 2000. p. 438-54. 120. Hernandez LJ, Jacobson JW, Harris MS. Comparison among the perforation rates of Maloney, balloon and Savary dilation of esophageal strictures. Gastrointest Endosc 2000;51: 460-1. 121. Lightdale CJ. Esophageal cancer. Am J Gastroenterol 1999; 94:20-9. 122. Carazzone A, Bonavina L, Segalin A, Ceriani C, Peracchia A. Endoscopic palliation of oesophageal cancer: results of a prospective comparison of Nd:YAG laser and ethanol injection. Eur J Surg 1999;165:351-6. 123. Jensen DM, Machicado G, Randall G, Tung LA, EnglishZych S. Comparison of low-power YAG laser and BICAP tumor probe for palliation of esophageal cancer strictures. Gastroenterol 1988;94:1263-70. 124. Carr-Locke DL, Conn MI, Faigel DO, Laing K, Leung JW, Mills M, et al. Developments in laser technology. Gastrointest Endosc. In press. 125. Heindorff H, Wojdemann M, Svendsen LB. Endoscopic palliation of inoperable cancer of the oesophagus or cardia by argon electrocoagulation. Scan J Gastroenterol 1998;33:21-3. 126. Overholt BF, Panjehpour M, Haydek JM. Photodynamic therapy for Barretts esophagus: follow-up in 100 patients. Gastrointest Endosc 1999;49:1-7. 127. Maier A, Tomaselli F, Gebhard F, Rehak P, Smolle J, SmolleJuttner FM. Palliation of advanced esophageal carcinoma by photodynamic therapy and irradiation. Ann Thorac Surg 2000;69:1006-9. 128. Knyrim K, Wagner HJ, Bethge N, Keymling M, Vakil N. A 792 GASTROINTESTINAL ENDOSCOPY

129.

130. 131.

132.

133.

134.

135.

136.

137.

138.

139.

140.

141.

142.

143.

144.

145.

controlled trial of an expansile metal stent for palliation of esophageal obstruction due to inoperable cancer. N Engl J Med 1993;329:1302-7. Carr-Locke DL, Branch MS, Byrne WJ, Conn MI, Laing K, Nelson DB, et al. Stents for gastrointestinal strictures. Gastrointest Endosc 1998;47:588-93. Faigel DO. Endoscopy for the diagnosis and management of esophageal cancer. ASGE Clinical Update 2000;8:1-4. Bartelsman JFW, Bruno MJ, Jensema AJ, Haringsma J, Reeders JWAJ, Tytgat GNJ. Palliation of patients with esophagogastric neoplasms by insertion of a covered expandable modified Gianturco-Z endoprosthesis: experinces in 153 patients. Gastrointest Endosc 2000;51:134-8. Siersema PD, Hop WCJ, van Blankenstein M, Dees J. A new metal stent (Flamingo stent) for palliation of malignant dysphagia: a prospective study. Gastrointest Endosc 2000;51:139-45. Kinsman KJ, DeGregorio BT, Katon RM, Morrison K, Saxon RR, Keller FS, Rsch J. Prior radiation and chemotherapy increase the risk of life-threatening complications after insertion of metallic stents for esophagogastric malignancy. Gastrointest Endosc 1996;43:196-203. Raijman I, Siddique I, Lynch P. Does chemoradiation therapy increase the incidence of complications with self-expanding coated stents in the management of malignant esophageal strictures. Am J Gastroenterol 1997;92:2192-6. Dua KS, Kozarek RA, Kim JP, Evans J, Hogan WJ, Shaker R. Anti-reflux self-expanding metal esophageal stent: clinical evaluation in patients. Gastrointest Endosc 2000;51: AB118. Raijman I, Siddique I, Ajani J, Lynch P. Palliation of malignant dysphagia and fistulae with coated expandable metal stents: experience in 101 patients. Gastrointest Endosc 1998;48:172-9. Sanowski RA, Waring JP. Endoscopic techniques and complications in variceal sclerotherapy. J Clin Gastroenterol 1987;9:504-13. Schuman BM, Beckman JW, Tedesco FJ, Griffin JW Jr, Assad RT. Complications of endoscopic injection sclerotherapy. A review. Am J Gastroenterol 1987;82:823-30. Zambelli A, Arcidiacano PG, Arcidiacano R et al. Complications of endoscopic variceal sclerotherapy (EVS): a multicenter study of 1192 patients. Gastroenterology 1993; 104:1023. Sarin S, Nanda R, Scahdev G, Chari S, Anand BS, Broor SL. Intravariceal versus paravariceal slcerotherapy: a prospective, controlled, randomized trial. Gut 1986;28:657-62. Piai G, Cipolletta L, Claar M, Marone G, Bianco MA, Forte G, et al. Prophylactic sclerotherapy of high risk esophageal varices: results of a multicentric prospective controlled trial. Hepatology 1988;8:1495-507. Sarin S, Sachdev G, Nanda R, Batra SK, Anand BS. Comparison of two time schedules for endoscopic sclerotherapy: a prospective randomized controlled study. Gut 1986;27:710-6. Westaby D, Melia W, McDougall B, Hegarty JE, Williams R. Injection sclerotherapy for oesophageal varices: a prospective randomised trial of different schedules. Gut 1984;25: 129-35. Tabibian N, Smith J, Graham D. Sclerotherapyassociated esophageal ulcers: lessons from a double-blind, randomised comparison of sucralfate suspension versus placebo. Gastrointest Endosc 1989;35:312-7. Poison RJ, Westaby D, Gimson, AE Hayes PC, Stellon AJ, Hayllar K, et al. Sucralfate for the prevention of early VOLUME 55, NO. 7, 2002

Title

Author

146.

147.

148.

149.

150.

151.

152.

153.

154.

155.

156.

157.

158.

159.

rebleeding following injection sclerotherapy for esophageal varices. Hepatology 1989;10:279-87. Tamura S, Shiozaki H, Kabayashi K, Yano H, Tahara H, Miyata M, et al. Prospective randomized study on the effect of ranitidine against injection ulcer after endoscopic injection sclerotherapy for esophageal varices. Am J Gastroenterol 1991;86:477. Garg PK, Sidhu SS, Bhargava DK. Role of omeprazole in prevention and treatment of postendoscopic variceal sclerotherapy esophageal complications. Double-blind randomized study. Dig Dis Sci 1995;40:1569. Gimson A, Poison R, Westaby D, Williams R. Omeprazole in the management of intractable esophageal ulceration following injection sclerotherapy. Gastroenterology 1990;99: 1829. Johlin FC, Labrecque DR, Neil GA. Omeprazole heals mucosal ulcers associated with endoscopic injection sclerotherapy. Dig Dis Sci 1992;37:1373. Copenhagen Esophageal Varices Sclerotherapy Project. Sclerotherapy after first variceal hemorrhage in cirrhosis. N Engl J Med 1984;311:1594. Heaton ND, Howard ER. Complications and limitations of injection sclerotherapy in portal hypertension. Gut 1993; 34:7-10. Koch H, Henning H, Grimm H, Soehendra N. Prophylactic sclerosing of esophageal varices-results of a prospective controlled study. Endoscopy 1986;18:40. Steigmann GV, Goff JS, Michaletz-Onody PA, Korula J, Lieberman D, Saeed ZA, et al. Endoscopic sclerotherapy as compared with endoscopic ligation for bleeding esophageal varices. N Engl J Med 1992;326:1527. Sorenson T, Burcharth F, Pedersen ML, Findahl F. Esophageal stricture and dysphagia after endoscopic sclerotherapy for bleeding varices. Gut 1984;25:473. Jensen DM, Kovacs TOG, Randall GM, et al. Initial results of a randomized prospective study of emergency banding vs sclerotherapy for bleeding gastric or esophageal varices. Gastrointest Endosc 1993;88:1493. Laine L, El-Newihi HM, Migikovsky B, Sloane R, Garcia F. Endoscopic ligation compared with sclerotherapy for the treatment of bleeding esophageal varices. Ann Int Med 1993;119:1. Lo GH, Lai KH, Cheng JS, Hwu JH, Chang CF, Chen SM, et al. A prospective randomized trial of sclerotherapy versus ligation in the management of bleeding esophageal varices. Hepatology 1995;22:466. Young MF, Sanowski RA, Rasche R. Comparison and characterization of ulcerations induced by endoscopic ligation of esophageal varices versus endoscopic sclerotherapy. Gastrointest Endosc 1993;39:119. Chen WC, Hou MC, Lin HC, Chang FY, Lee SD, et al. Symptomatic esophageal stricture after endoscopic variceal ligation-success of endoscopic balloon dilation. Chung Hua I Hseuh Tsa Chih 2000;63:144-7.

160. Rai RR, Nijhawan S, Singh G. Post-ligation stricture: a rare complication. Endoscopy 1996;28:406. 161. Fleischer DE. Therapy for gastrointestinal bleeding. In: Geenen JE, Fleischer DE, Waye JD, editors. Techniques in therapeutic endoscopy. 2nd ed. New York: Gower Medical Publ. 1.1-1.27. 162. Chung SS, Lau JY, Sung JJ, Chan AC, Lai CW, Ng EK, et al. Randomised comparison between adrenaline injection alone plus heat probe treatment for actively bleeding ulcers.BMJ 1997;314:1307-11. 163. Lin HJ, Tseng GY, Perng CL, Lee FY, Chang FY, Lee SD. Comparison of adrenaline injection and bipolar electrocoagulation for the arrest of peptic ulcer bleeding. Gut 1999;44: 715-9. 164. Rutgeerts P, Vantrappen G, Van Hootegem P, Broeckaert L, Janssens J, Coremans G, et al. Neodymium-YAG laser photocoagulation versus electrocoagulation for the treatment of severely bleeding ulcers: a randomised comparison. Gastrointest Endosc 1987;33:199-202. 165. Jensen DM. Endoscopic control of nonvariceal upper gastrointestinal hemorrhage. In Yamada T, Alpers DH, Laine L, Owyang C, Powell DW, editors. Textbook of gastroenterology. Phildelphia: Lippincott Williams and Wilkins; 1999. p. 2857-79. 166. Lau JY, Sung JJ, Lam YH, Chan AC, Ng EK, Lee DW, et al. Endoscopic retreatment compared with surgery in patients with recurrent bleeding after initial endoscopic control of bleeding ulcers. N Engl J Med 1999;34:751-6. 167. VanOsEC, Kamath PS, Gostout CJ, Heit JA. Gastroenterological procedures among patients with disorders of hemostasis: evaluation and management recommendations. Gastrointest Endosc 1999;50:536-43. 168. Kao LS, Nguyen T, Dominitz J, Teicher HL, Kearney DJ. Modification of a latex glove for the safe endoscopic removal of a sharp gastric foreign body. Gastrointest Endosc 2000; 52:127-9.

Prepared by: Standards of Practice Committee Glenn M. Eisen, MD, Chair Todd H. Baron, MD Jason A. Dominitz, MD Douglas O. Faigel, MD Jay L. Goldstein, MD John F. Johanson, MD J. Shawn Mallery, MD Hareth M. Raddawi, MD John J. Vargo II, MD J. Patrick Waring, MD Robert D. Fanelli, SAGES Rep Jo Wheeler-Harbough, SGNA Rep

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