Korean J Gastroenterol.  2022 May;79(5):210-216. 10.4166/kjg.2022.024.

Factors Associated with the Clinical Outcomes of Iatrogenic Colonic Perforation

Affiliations
  • 1Department of Internal Medicine, Myongji Hospital, Goyang, Korea
  • 2Department of Internal Medicine, College of Medicine, the Catholic University of Korea, Seoul, Korea

Abstract

Background/Aims
This study evaluated the incidence of iatrogenic colonic perforation (ICP) in a high-volume center and analyzed the clinical outcomes and associated factors.
Methods
As a retrospective study of the electronic medical records, the whole data of patients who underwent colonoscopy from June 2004 to May 2020 were reviewed.
Results
During 16 years, 69,458 procedures were performed, of which 60,288 were diagnostic and 9,170 were therapeutic. ICP occurred in 0.027% (16/60,288) for diagnostic colonoscopies and in 0.076% (7/9,170) for therapeutic purposes (p=0.015; hazard ratio 2.878; 95% CI, 1.184-6.997). Fifty-two percent (12 cases) were managed with endoscopic clip closure, and 43.5% (10 cases) required surgery. The reasons for the procedure and the procedure timing appeared to affect the treatment decision. Perforations during therapeutic colonoscopy were treated with surgery more often than those for diagnostic purposes (66.7% [4/6] vs. 37.5% [6/16], p=0.221). Regarding the timing of the procedure, ICP that occurred in the afternoon session was more likely treated surgically (56.3% [9/16] vs. 0/5, p=0.027). Mortality occurred in two patients (2/23, 8.7%). Both were aged (mean age 84.0±1.4 vs. 65.7±10.5, p<0.001) and lately recognized (mean elapsed time [hours], 43.8±52.5 vs. 1.5±3.0, p<0.001) than the surviving patients.
Conclusions
ICP occurs in less than 0.1% of cases. The events that occurred during the morning session were more likely managed endoscopically. Age over 80 years and a longer time before perforation recognition were associated with mortality.

Keyword

Colonoscopy; Colon; Perforation; Mortality

Figure

  • Fig. 1 Perforation site (%).


Reference

1. Kothari ST, Huang RJ, Shaukat A, et al. 2019; ASGE review of adverse events in colonoscopy. Gastrointest Endosc. 90:863–876. e33. DOI: 10.1016/j.gie.2019.07.033. PMID: 31563271.
Article
2. Lim DR, Kuk JK, Kim T, Shin EJ. 2020; The analysis of outcomes of surgical management for colonoscopic perforations: a 16-years experiences at a single institution. Asian J Surg. 43:577–584. DOI: 10.1016/j.asjsur.2019.07.013. PMID: 31400954.
Article
3. déAngelis N, Di Saverio S, Chiara O, et al. 2018; 2017 WSES guidelines for the management of iatrogenic colonoscopy perforation. World J Emerg Surg. 13:5. DOI: 10.1186/s13017-018-0162-9. PMID: 29416554. PMCID: PMC5784542.
4. Cha RR, Kim HJ, Lee CM, et al. Clinical characteristics and outcome of iatrogenic colonic perforation related to diagnostic vs. therapeutic colonoscopy. Surg Endosc. 2022; Jan. 19. [Epub ahead of print]. DOI: 10.1007/s00464-022-09010-6.
Article
5. Markar SR, Lagergren J. 2020; Surgical and surgeon-related factors related to long-term survival in esophageal cancer: a review. Ann Surg Oncol. 27:718–723. DOI: 10.1245/s10434-019-07966-9. PMID: 31691111. PMCID: PMC7000496.
Article
6. Rabeneck L, Paszat LF, Hilsden RJ, et al. 2008; Bleeding and perforation after outpatient colonoscopy and their risk factors in usual clinical practice. Gastroenterology. 135:1899–1906.e1. DOI: 10.1053/j.gastro.2008.08.058. PMID: 18938166.
Article
7. Lüning TH, Keemers-Gels ME, Barendregt WB, Tan AC, Rosman C. 2007; Colonoscopic perforations: a review of 30,366 patients. Surg Endosc. 21:994–997. DOI: 10.1007/s00464-007-9251-7. PMID: 17453289.
Article
8. Alsowaina KN, Ahmed MA, Alkhamesi NA, et al. 2019; Management of colonoscopic perforation: a systematic review and treatment algorithm. Surg Endosc. 33:3889–3898. DOI: 10.1007/s00464-019-07064-7. PMID: 31451923.
Article
9. Oh JE, Shim SG. 2009; Colonoscopic perforation; a 10-year experience in single general hospital. Korean J Gastroenterol. 54:371–376. DOI: 10.4166/kjg.2009.54.6.371. PMID: 20026891.
Article
10. Kooyker AI, Toes-Zoutendijk E, Opstal-van Winden AWJ, et al. 2021; Colonoscopy-related mortality in a fecal immunochemical test-based colorectal cancer screening program. Clin Gastroenterol Hepatol. 19:1418–1425. DOI: 10.1016/j.cgh.2020.07.066. PMID: 32777553.
Article
11. Benazzato L, Zorzi M, Antonelli G, et al. 2021; Colonoscopy-related adverse events and mortality in an Italian organized colorectal cancer screening program. Endoscopy. 53:501–508. DOI: 10.1055/a-1228-9225. PMID: 32725616.
Article
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