Rare complication of upper gastrointestinal endoscopy: doubled-back endoscope in the esophagus.

gastrointestinal endoscopy are perfora− tion and hemorrhage. Our case report de− scribes a rare complication that occurred during diagnostic endoscopy. A 53−year−old man with diabetes was ad− mitted to our department because of dis− turbed carbohydrate balance. Because he was suffering from epigastric pain and re− current coffee−ground vomiting (he was on continuous antiplatelet agent ther− apy), upper gastrointestinal endoscopy was performed. During the procedure some coffee−ground fluid was observed in the stomach; nevertheless, the inspect− ed mucosa appeared to be intact. During retroflexion the fiberscope slipped back into the esophagus and resisted manual extraction. Chest and abdominal X−ray confirmed that the endoscope had reached up high into the esophagus, al− most to the hypopharynx, while being doubled back in a U−shape in the stomach (l" Fig. 1, 2). Since manual extraction of the endoscope was unsuccessful, laparotomy was per− formed. The twisted U−shape of the endo− scope was then directly palpable in the stomach. Pulling the endoscope gently from the upper end, both portions of the instrument in the stomach were identi− fied. The endoscope was straightened and pulled out of the esophagus success− fully without a gastrotomy. Despite the increasing number of upper gastrointestinal endoscopies being per− formed worldwide, the complication rate remains low (0.018± 0.7 %) [1]. In cases of urgent endoscopy because of acute gas− trointestinal bleeding, the complication rate is higher (2.82 %) [2]. Retroflexion is part of a routine proce− dure: the subcardial region can be exam− ined substantially only in this way. Im− paction of the fiberscope is not unknown, but it is a very rare complication [3]. In the case report of Döbrönte the endo− scope was successfully pulled out with the aid of a second endoscope [4]. In our case, however, this procedure could not be performed because of the high impac− tion and risk of esophageal perforation; instead, the fiberscope was removed in− tact using laparotomy but not gastro− tomy.