controlled by conservative measures, an unrecognized perforation in this area can also have fatal consequences. The site of perforation is the cervical esophagus in 40% of patients, the midesophagus in 25%, and the distal esophagus in 35%.1 • Females appear to be more likely to have cervical perforations, whereas male patients more commonly develop perforations in the thoracic esophagus. Rigid esophagoscopes account for relatively more perforations than do flexible scopes (80% of the total in one series), although the actual distribution varies according to the frequency with which each technique is used. Cervical spine disease is a risk factor for perforation, particularly in patients undergoing rigid esophagoscopy, as are inflammation and stricture.
Significant bleeding following flexible or rigid esophagoscopy is uncommon, occurring in 0.01 to 0.1% of cases. It arises more commonly in the stomach than in the esophagus and is usually secondary to an aggressive biopsy, injury to pre-existing varices, or, in some cases, a Mallory-Weiss tear during or shortly after esophagoscopy. Cardiopulmonary Complications
Cardiopulmonary complications arising from endoscopy include aspiration pneumonia, cardiac arrhythmias, hypoxemia, respiratory arrest, and cardiac arrest. The latter three complications may also be ascribed to errors in administration of sedation. Stimulation of the glottis may lead to a vagally induced bradycardia. Other arrhythmias encountered include sinus tachycardia, ventricular and atrial premature beats, and,
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