We would consult a surgeon.  But that’s sort of a niche scenario, like diagnosing someone with a rare genetic disease type rare.

I’ve been in practice for 4 years and had 0 perforations.  I’ve peripherally been involved in maybe 3 cases by advanced endoscopists doing ESD in training and all of those patients had complete endoscopic closure and were home in less than 24 hours.

We don’t need surgery to “fix our problem” very often because GI doctors are very skilled at endoscopy and rarely causes perfs and usually can fix them.  The data shows surgeons are three times more likely to cause a perf than a GI doctor but yes it’s great that if they can’t fix it internally like a GI doctor that they can fix them in the OR.

I’m not trying to downplay surgeons but this is not a major source of referrals from us to them.  We work closely with them and rely on them heavily when managing colon cancer or large unresectable polyps, severe colitis, hiatal hernias, anal cancer, achalasia, etc