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Incidence of colonoscopy-related perforation and risk factors for poor outcomes: 3-year results from a prospective, multicenter registry (with videos)

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Abstract

Background and aims

Perforation is a life-threatening adverse event of colonoscopy that often requires hospitalization and surgery. We aimed to prospectively assess the incidence of colonoscopy-related perforation in a multicenter registry and to analyze the clinical factors associated with poor clinical outcomes.

Methods

This prospective observational study was conducted at six tertiary referral hospitals between 2017 and 2020, and included patients with colonic perforation after colonoscopy. Poor clinical outcomes were defined as mortality, surgery, and prolonged hospitalization (> 13 days). Logistic regression was used to identify factors associated with poor clinical outcomes.

Results

Among 84,673 patients undergoing colonoscopy, 56 had colon perforation (0.66/1000, 95% confidence interval [CI] 0.51–0.86). Perforation occurred in 12 of 63,602 diagnostic colonoscopies (0.19/1000, 95% CI 0.11–0.33) and 44 of 21,071 therapeutic colonoscopies (2.09/1000, 95% CI 1.55–2.81). Of these, 15 (26.8%) patients underwent surgery, and 25 (44.6%) patients had a prolonged hospital stay. One patient (1.8%) died after perforation from a diagnostic colonoscopy. In the multivariate analysis, diagnostic colonoscopy (adjusted odds ratio [aOR] 196.43, p = 0.025) and abdominal rebound tenderness (aOR 17.82, p = 0.012) were independent risk factors for surgical treatment. The location of the sigmoid colon (aOR 18.57, p = 0.048), delayed recognition (aOR 187.71, p = 0.008), and abdominal tenderness (aOR 63.20, p = 0.017) were independent risk factors for prolonged hospitalization.

Conclusions

This prospective study demonstrated that the incidence of colonoscopy-related perforation was 0.66/1000. The incidence rate was higher in therapeutic colonoscopy, whereas the risk for undergoing surgery was higher in patients undergoing diagnostic colonoscopy. Colonoscopy indication (diagnostic vs. therapeutic), physical signs, the location of the sigmoid perforation, and delayed recognition were independent risk factors for poor clinical outcomes in colonoscopy-related perforation.

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Acknowledgements

We thank nurses in each hospital for their work and support of this perforation registry.

Funding

Grants from the National Research Foundation (NRF) of Korea (NRF-2020R1F1A1066115, 2021R1A5A2021614).

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Authors and Affiliations

  1. Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Kyungpook National University, 130 Dongdeuk-ro, Jung-gu, Daegu, 41944, Korea

    Jieun Lee, Jong Won Seo, Eun Soo Kim, Sung Kook Kim, Min Kyu Jung, Jun Heo, Hyun Seok Lee & Joon Seop Lee

  2. Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea

    Yoo Jin Lee & Kwang Bum Cho

  3. Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea

    Byung Ik Jang & Kyeong Ok Kim

  4. Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea

    Eun Young Kim

  5. Department of Internal Medicine, Daegu Fatima Hospital, Daegu, Korea

    Dae Jin Kim & Yun Jin Chung

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On behalf of Daegu-Gyeongbuk Gastrointestinal Study Group

Corresponding author

Correspondence to Eun Soo Kim.

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Disclosures

Dr. Jieun Lee, Dr. Eun Soo Kim, Dr. Yoo Jin Lee, Dr. Jong Won Seo, Dr. Sung Kook Kim, Dr. Min Kyu Jung, Dr. Jun Heo, Dr. Hyun Seok Lee, Dr. Joon Seop Lee, Dr. Byung Ik Jang, Dr. Kyeong Ok Kim, Dr. Kwang Bum Cho, Dr. Eun Young Kim, Dr. Dae Jin Kim, and Dr. Yun Jin Chung have no conflicts of interest of financial ties to disclose.

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Supplementary file1 (DOCX 14 KB)

Supplementary file2 Video 1 Colonic perforation during diagnostic colonoscopy. While passing through the acute angulation of the sigmoid colon, a perforation suddenly occurred at the tip of the colonoscope. Endoscopic clip application failed due to a huge perforation of the full-thickness colonic wall. (MP4 14691 KB)

Supplementary file3 Video 2 This video shows the successful closure of the perforation that occurred during therapeutic colonoscopy (endoscopic mucosal resection) of the case in Fig 2 using endoscopic clipping. (MP4 15667 KB)

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Lee, J., Lee, Y.J., Seo, J.W. et al. Incidence of colonoscopy-related perforation and risk factors for poor outcomes: 3-year results from a prospective, multicenter registry (with videos). Surg Endosc 37, 5865–5874 (2023). https://doi.org/10.1007/s00464-023-10046-5

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