Colonoscopic perforation: A report from World Gastroenterology Organization endoscopy training center in Thailand

Abstract

AIM:To determine the incidence of colonoscopic perforation (CP), and evaluate clinical findings, management and outcomes of patients with CP from the World Gastroenterology Organization (WGO) Endoscopy Training Center in Thailand. METHODS: All colonoscopies and sigmoidoscopies performed between 1999 and 2007 in the Endoscopic unit, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok were reviewed. Incidence of CP, patients' characteristics, endoscopic information, intraoperative findings, management and outcomes were analyzed. RESULTS: A total of 17 357 endoscopic procedures of the colon (13 699 colonoscopies and 3658 flexible sigmoidoscopies) were performed in Siriraj hospital over a 9-year period. Fifteen patients (0.09%) had CP: 14 from colonoscopy and 1 from sigmoidoscopy. The most common site of perforation was in the sigmoid colon (80%), followed by the transverse colon (13%). Perforations were caused by direct trauma from either the shaft or the tip of the endoscope (n = 12, 80%) and endoscopic polypectomy (n = 3, 20%). All patients with CP underwent surgical management: primary repair (27%) and bowel resection (73%). The mortality rate was 13% and postoperative complication rate was 53%. CONCLUSION: CP is a rare but serious complication following colonoscopy and sigmoidoscopy, with high rates of morbidity and mortality. Incidence of CP was 0.09%. Surgery is still the mainstay of CP management.

Propofol-based sedation does not increase rate of perforation during colonoscopic procedur

“…In our present study, the rate of CP with or without propofol-based sedation was relatively higher than in our previous report 16 and other published series [1][2][3][4][5][6] (0.25% and 0.20% vs. 0.03-0.09%). One possible explanation of this difference is that the number of colonoscopies has increased markedly over the last few years.…”

“…If flexible sigmoidoscopy and colonoscopy done with IVS and other anesthetic techniques were included, the CP rate in our center was 0.09%. 16 However, the previous series did not mention the frequently used anesthesia/sedation technique. In our present study, we selectively collected the patients who underwent colonoscopy, not flexible sigmoidoscopy, by using the IVS technique.…”

Jatrogeninė kolonoskopinė storosios žarnos perforacija: vieno centro chirurginio gydymo rezultatai

“…The mortality rate in our study is fairly comparable to other reports which is up to 25% [7,8]. Surgical site infection is the most common complication, while cardiopulmonary complications and multiple organ failure are the leading causes of death [7,24]. Iqbal et al noted that patients presenting after 24 hours have morbidity nearly twice as frequently as patients who present within 24 hours [7].…”

What Are the Risk Factors of Colonoscopic Perforation?

“…There were 8 perforations among the diagnostic colonoscopies (1.0 per 1000 procedures) and 7 perforations among the therapeutic colonoscopies (2.9 per 1000 procedures). These incidences were 2-3 times higher than those of our previous review, in which the incidence of perforation from colonoscopy was 0.1% and from sigmoidoscopy was Abbreviation: D = Diagnostic endoscopy, T = Therapeutic endoscopy, TIP = mechanical trauma from the tip of scope, SHAFT = mechanical trauma from the shaft of scope 0.03% [3]. One possible explanation of this finding is that the number of colonoscopies and endoscopic procedures has remarkably increased over the last few years, and more colonoscopies are being performed by trainees in our institute.…”

“…Recently, we have reported a CP rate of 0.09% from 17,357 endoscopic procedures between 1999 and 2007 in our institute. This was associated with 13% mor-tality and 53% morbidity [3]. Recently, two extensive reviews of the outcomes following CP by Iqbal [4] and Teoh [5] showed a mortality rate of 7-26% and a morbidity rate of 37-49%, together with a 38% rate of intestinal stoma formation.…”