Complications of esophagoscopy in an academic training program

Abstract

Objective: To assess the efficacy and safety of flexible versus rigid esophagoscopy in an academic training setting.

Study design: Case series with chart review.

Setting: Tertiary academic training center.

Subjects and methods: A retrospective medical record review was performed on all adult patients undergoing esophagoscopy from 2002 to 2007.

Results: A total of 546 procedures were performed with flexible (n = 276) or rigid (n = 270) endoscopes. Seven esophageal perforations (2.6%) occurred, all in association with rigid endoscopy and all in patients with a history of head and neck cancer. Esophageal perforation rates were associated with attending level of experience. There were no deaths. No synchronous esophageal cancers were found in any patient undergoing panendoscopy for the evaluation of a head and neck cancer.

Conclusion: The 2.6 percent esophageal perforation rate observed in this study is higher than that typically reported for rigid esophagoscopy. When performed as part of routine panendoscopy, no synchronous esophageal tumors were found, questioning the value of esophagoscopy in this setting. All perforations occurred in patients with a history of head and neck cancer and were associated with the level of the surgeon's experience in performing rigid endoscopy.