Percutaneous needle decompression for endoscopic iatrogenic pneumoperitoneum: assessment of safety and efficacy in real world practice

Iatrogenic perforation during endoscopy can rapidly lead to tension pneumoperitoneum, impairing visualisation and causing cardiopulmonary compromise. We describe a multicentre experience using percutaneous needle decompression to manage pneumoperitoneum during endoscopy. Across 60 cases over more than a decade, decompression was uniformly successful, without procedure-related adverse events and enabled completion of the index endoscopic procedure in 98% of patients. These findings support percutaneous needle decompression as a simple, safe and effective adjunct in the acute management of endoscopy-related perforation.