Abstract
Background
The incidence of colonoscopic perforation has increased following the widespread use of colonoscopy for the diagnosis and treatment of colorectal disease. The purpose of our study was to compare the clinical outcomes between surgical and non-surgical treatment of colonoscopic perforation.
Methods
We retrospectively reviewed the medical records of patients with colonoscopic perforation, which was treated between January 2005 and December 2014. Patients were divided into two groups depending on whether they received non-surgical (conservative management or endoscopic clipping) or surgical (primary closure, bowel resection and anastomosis, and/or faecal diversion) initial treatment for the perforation. Conversion was defined as the change from a non-surgical to surgical procedure after treatment failure.
Results
One hundred and nine patients were analysed. Surgical treatment was more common following diagnostic than therapeutic colonoscopic procedures (74.5 vs. 53.7 %, P = 0.023). Of 55 patients in the non-surgical group, 11 patients required conversion to surgery. The surgical group comprised 54 patients. The complication rate (P = 0.001), and the length of hospital stay (P < 0.001) were significantly greater in the patients requiring conversion than in the surgical group. Multivariate analysis showed that old age, American Society for Anesthesiologists score ≥ 3, and conversion were independent predictors of poor outcomes (P = 0.048, 0.032, and 0.001, respectively). Only perforation size was associated with conversion in multivariate analysis (P = 0.022).
Conclusion
It is important to select an appropriate treatment in patients with colonoscopic perforation. To avoid non-surgical treatment failure, surgery should be considered in patients with a large perforation. By decreasing the rate of conversion, we might reduce the complication and mortality rates associated with colonoscopic perforation.
Similar content being viewed by others
References
Garbay JR, Suc B, Rotman N, Fourtanier G, Escat J (1996) Multicentre study of surgical complications of colonoscopy. Br J Surg 83:42–44
Macrae FA, Tan KG, Williams CB (1983) Towards safer colonoscopy: a report on the complications of 5000 diagnostic or therapeutic colonoscopies. Gut 24:376–383
Lohsiriwat V, Sujarittanakarn S, Akaraviputh T, Lertakyamanee N, Lohsiriwat D, Kachinthorn U (2009) What are the risk factors of colonoscopic perforation? BMC Gastroenterol 9:71
Okholm C, Hadikhadem T, Andersen LT, Donatsky AM, Vilmann P, Achiam MP (2013) No increased risk of perforation during colonoscopy in patients undergoing Nurse Administered Propofol Sedation. Scand J Gastroenterol 48:1333–1338
Iqbal CW, Cullinane DC, Schiller HJ, Sawyer MD, Zietlow SP, Farley DR (2008) Surgical management and outcomes of 165 colonoscopic perforations from a single institution. Arch Surg 143:701–706
Teoh AY, Poon CM, Lee JF, Leong HT, Ng SS, Sung JJ et al (2009) Outcomes and predictors of mortality and stoma formation in surgical management of colonoscopic perforations: a multicenter review. Arch Surg 144:9–13
Luning TH, Keemers-Gels ME, Barendregt WB, Tan AC, Rosman C (2007) Colonoscopic perforations: a review of 30,366 patients. Surg Endosc 21:994–997
Yang DH, Byeon JS, Lee KH, Yoon SM, Kim KJ, Ye BD et al (2010) Is endoscopic closure with clips effective for both diagnostic and therapeutic colonoscopy-associated bowel perforation? Surg Endosc 24:1177–1185
Magdeburg R, Collet P, Post S, Kaehler G (2008) Endoclipping of iatrogenic colonic perforation to avoid surgery. Surg Endosc 22:1500–1504
Kim JS, Kim BW, Kim JI, Kim JH, Kim SW, Ji JS et al (2013) Endoscopic clip closure versus surgery for the treatment of iatrogenic colon perforations developed during diagnostic colonoscopy: a review of 115,285 patients. Surg Endosc 27:501–504
Kim J, Lee GJ, Baek JH, Lee WS (2014) Comparison of the surgical outcomes of laparoscopic versus open surgery for colon perforation during colonoscopy. Ann Surg Treat Res 87:139–143
Zhang YQ, Lu W, Yao LQ, Qin XY, Xu MD, Zhong YS et al (2013) Laparoscopic direct suture of perforation after diagnostic colonoscopy. Int J Colorectal Dis 28:1505–1509
Wullstein C, Koppen M, Gross E (1999) Laparoscopic treatment of colonic perforations related to colonoscopy. Surg Endosc 13:484–487
Velez MA, Riff DS, Mule JM (1997) Laparoscopic repair of a colonoscopic perforation. Surg Endosc 11:387–389
Hansen AJ, Tessier DJ, Anderson ML, Schlinkert RT (2007) Laparoscopic repair of colonoscopic perforations: indications and guidelines. J Gastrointest Surg 11:655–659
Tulchinsky H, Madhala-Givon O, Wasserberg N, Lelcuk S, Niv Y (2006) Incidence and management of colonoscopic perforations: 8 years’ experience. World J Gastroenterol 12:4211–4213
Gatto NM, Frucht H, Sundararajan V, Jacobson JS, Grann VR, Neugut AI (2003) Risk of perforation after colonoscopy and sigmoidoscopy: a population-based study. J Natl Cancer Inst 95:230–236
Araghizadeh FY, Timmcke AE, Opelka FG, Hicks TC, Beck DE (2001) Colonoscopic perforations. Dis Colon Rectum 44:713–716
Carpio G, Albu E, Gumbs MA, Gerst PH (1989) Management of colonic perforation after colonoscopy. Report of three cases. Dis Colon Rectum 32:624–626
Avgerinos DV, Llaguna OH, Lo AY, Leitman IM (2008) Evolving management of colonoscopic perforations. J Gastrointest Surg 12:1783–1789
Lo AY, Beaton HL (1994) Selective management of colonoscopic perforations. J Am Coll Surg 179:333–337
George SM Jr, Fabian TC, Voeller GR, Kudsk KA, Mangiante EC, Britt LG (1989) Primary repair of colon wounds. A prospective trial in nonselected patients. Ann Surg 209:728–733
Miyahara M, Kitano S, Shimoda K, Bandoh T, Chikuba K, Maeo S et al (1996) Laparoscopic repair of a colonic perforation sustained during colonoscopy. Surg Endosc 10:352–353
Clements RH, Jordan LM, Webb WA (2000) Critical decisions in the management of endoscopic perforations of the colon. Am Surg 66:91–93
Iqbal CW, Chun YS, Farley DR (2005) Colonoscopic perforations: a retrospective review. J Gastrointest Surg 9:1229–1235
Hall C, Dorricott NJ, Donovan IA, Neoptolemos JP (1991) Colon perforation during colonoscopy: surgical versus conservative management. Br J Surg 78:542–544
Orsoni P, Berdah S, Verrier C, Caamano A, Sastre B, Boutboul R et al (1997) Colonic perforation due to colonoscopy: a retrospective study of 48 cases. Endoscopy 29:160–164
Damore LJ 2nd, Rantis PC, Vernava AM 3rd, Longo WE (1996) Colonoscopic perforations. Etiology, diagnosis, and management. Dis Colon Rectum 39:1308–1314
Gedebou TM, Wong RA, Rappaport WD, Jaffe P, Kahsai D, Hunter GC (1996) Clinical presentation and management of iatrogenic colon perforations. Am J Surg 172:454–457
Acknowledgments
The authors were grateful for the comments made by professor Dae Kyung Sohn at the National Cancer Center, Republic of Korea.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosures
Sung Bak An, Dong Woo Shin, Jeong Yeon Kim, Sung Gil Park, Bong Hwa Lee, and Jong Wan Kim have no conflicts of interests.
Rights and permissions
About this article
Cite this article
An, S.B., Shin, D.W., Kim, J.Y. et al. Decision-making in the management of colonoscopic perforation: a multicentre retrospective study. Surg Endosc 30, 2914–2921 (2016). https://doi.org/10.1007/s00464-015-4577-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-015-4577-z