Management of iatrogenic perforation

The modern era has seen a dramatic rise in the use of diagnostic and therapeutic endoscopy. Reasons for the greater use of endoscopy include technologic advancements of endoscopes and accessories, easier accessibility, increasing demand for nonsurgical therapies, and ever-expanding indications. In addition to understanding the contraindications and indications for endoscopy, an endoscopist must recognize and appropriately manage its complications, especially the life-threatening complication of perforation. Managing the patient with a gastrointestinal tract perforation is complex and requires the wisdom of the gastroenterologist, thoracic or general surgeon, and primary care physician. Ultimately, the optimal treatment of gastrointestinal tract perforation is avoiding one. This article reviews the current management of iatrogenic (instrumental) perforation of the stomach, small intestine, and colon, highlighting historical and evolving controversies. Esophageal perforation and management are discussed elsewhere in this issue.