Third space endoscopy pulmonary complications and chylothorax post peroral endoscopic myotomy

Table 1 The adverse events in gastrointestinal endoscopy classification

Grading	Definition
No adverse event	A telephone contact with the general practitioner, outpatient clinic, or endoscopy service without any intervention or extended observation of the patient after the procedure, < 3 hours, without any intervention
Grade I	Adverse events with any deviation of the standard postprocedural course, without the need for pharmacologic treatment or endoscopic, radiologic, or surgical interventions
	Presentation at the emergency ward, without any intervention
	Hospital admission (< 24 hours), without any intervention
	Allowed therapeutic regimens are drugs as antiemetics, antipyretics, analgesics, and electrolytes
	Allowed diagnostic tests: Radiology and laboratory tests
Grade II	Adverse events requiring pharmacologic treatment with drugs other than those allowed for grade I adverse events (i.e., antibiotics, antithrombotics, etc.)
	Blood or blood product transfusions
	Hospital admission for more than 24 hours
Grade III	Adverse events requiring endoscopic, radiologic, or surgical intervention
Grade IIIa	Endoscopic or radiologic intervention
Grade IIIb	Surgical intervention
Grade IV	Adverse events requiring intensive care unit/critical care unit admission
Grade IVa	Single-organ dysfunction (including dialysis)
Grade IVb	Multiorgan dysfunction
Grade V	Death

Definition of adverse event: All negative outcomes for a patient that prevent completion of the planned procedure or cause any deviation from the standard postprocedural course.

Table 2 Classification of adverse events of third space endoscopy[18]

Category	Type of adverse event
Severe	Any events requiring prolongation of hospital for > 10 days and ICU admission > 1 night
	Insufflation related events
	Causing hemodynamic instability
	Requiring premature termination of procedure ± drainage
	Mucosal injury (during or after)
	Requiring special closure techniques (stenting/sponge/surgery/drainage)
	Bleeding (during or after)
	Requiring blood transfusion
	Causing hemodynamic instability
	Endoscopic reintervention or surgery
	Post procedure leak
	Requiring endoscopic reintervention, drainage or surgery
	Cardiopulmonary events
	Causing hemodynamic instability
	Requiring premature termination of procedure
	Infection
	Causing hemodynamic instability requiring antibiotics ± drainage or surgery
Moderate	Any events requiring prolongation of hospital for 4-10 days and ICU admission for 1 day
	Insufflation related events with high probability of hemodynamic compromise requiring prolonged withholding of procedure (15 minutes) ± immediate drainage
	Capno-pericardium
	Mediastinal emphysema
	Tension pneumothorax
	Pleural effusion (during or after)
	Requiring drainage ± antibiotics
Mild	Insufflation related events requiring temporary withholding of procedure ± drainage
	Retroperitoneum
	Pneumothora
	Capno-peritoneum
	Mucosal injury (during or after) which can closed endoscopically
	Bleeding (during or after) not requiring blood transfusion or additional endoscopic intervention
	Infection requiring prolonged antibiotics
Not an adverse event	Insufflation related events not requiring any measures and accidently detected during fluoroscopy
	Small pneumothorax
	Small pneumoperitoneum
	Retroperitoneum
	Mild mediastinal emphysema
	Subcutaneous emphysema

Citation: Chavan R, Nabi Z, Reddy DN. Adverse events associated with third space endoscopy: Diagnosis and management. Int J Gastrointest Interv 2020; 9: 86-97. Copyright © International Journal of Gastrointestinal Intervention. Published by The Society of Gastrointestinal Intervention. Powered by INFOrang Co., Ltd. ICU: Intensive care unit.