Cervical esophageal perforation during EUS: a national survey

Background: EUS is considered to be as safe a procedure as EGD, However, th e longer, rigid tip of the echoendoscopes raises concern about cervical eso phageal perforation during intubation. Our aim was to determine the rate of this complication. Methods: Members of the American Endosonography Club were surveyed by quest ionnaire to determine the number of EUS examinations performed and the numb er of cervical esophageal perforations encountered up to June 1999, Each qu estionnaire was coded to avoid duplicate reporting. Results: Questionnaires were mailed to 203 members; 86 (42.4%) responded, C ervical esophageal perforation occurred in 16 of 43,852 reported upper EUS procedures at a frequency of 0.03%, Fifteen (94%) patients were elderly. A history of difficult intubation with prior endoscopic procedures was presen t in 7 (44%) patients. Three patients had large cervical osteophytes. In 9 (56%) patients, the procedure was done by an endosonographer with less than 1 year of experience. Two patients required surgery. One patient died as a result of the perforation and the other 13 (81%) patients were managed suc cessfully with conservative treatment. Conclusions: The incidence of cervical perforation during upper EUS may be higher than during EGD. Advanced patient age, difficult intubation during p rior upper endoscopy, operator inexperience, and the presence of large cerv ical osteophytes may contribute to cervical perforation during upper EUS ex amination.