Colonoscopy perforation rate, mechanisms and outcome: from diagnostic to therapeutic colonoscopy

Panteris, Vasileios; Haringsma, Jelle; Kuipers, Ernst J.

doi:10.1055/s-0029-1215179

Cited by 240 publications

(197 citation statements)

References 84 publications

(89 reference statements)

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“…Bowel preparation and the endoscopy are unpleasant, and the risk of perforation during colonoscopy itself is one in 1000. 21,22 Flexible sigmoidoscopy is much better tolerated and regarded as a low-risk procedure with perforation in one in 40 000 procedures. 23 A decision of a pre-treatment endoscopic evaluation should balance the risk of TAIinduced perforation with the risk, cost and the availability of endoscopy.…”

Section: Indications and Contraindicationsmentioning

confidence: 99%

Consensus review of best practice of transanal irrigation in adults

et al. 2013

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Study design: Review article. Objectives: To provide a consensus expert review of the treatment modality for transanal irrigation (TAI). Methods: A consensus group of specialists from a range of nations and disciplines who have experience in prescribing and monitoring patients using TAI worked together assimilating both the emerging literature and rapidly accruing clinical expertise. Consensus was reached by a round table discussion process, with individual members leading the article write-up in the sections where they had particular expertise. Results: Detailed trouble-shooting tips and an algorithm of care to assist professionals with patient selection, management and follow-up was developed. Conclusion: This expert review provides a practical adjunct to training for the emerging therapeutic area of TAI. Careful patient selection, directly supervised training and sustained follow-up are key to optimise outcomes with the technique. Adopting a tailored, stepped approach to care is important in the heterogeneous patient groups to whom TAI may be applied. Sponsorship: The review was financially supported by Coloplast A/S.

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Section: Indications and Contraindicationsmentioning

confidence: 99%

Consensus review of best practice of transanal irrigation in adults

et al. 2013

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“…Recent estimates place perforation rates after a colonoscopy at 1 in 1,400 among all patients who have a colonoscopy [2]. Fortunately, the mortality rate is low ranging from 0 to a high of 0.02% [2].…”

Section: Discussionmentioning

confidence: 99%

Rigler sign: a subtle finding of pneumoperitoneum

et al. 2010

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A 75-year-old woman with a past medical history of hypertension, presented to the emergency department (ED) with 12 h of persistent, non-radiating, diffuse abdominal pain. The patient had undergone a colonoscopy the day before. A chest X-ray study was done in the ED after the patient was sitting upright for at least 10 min, but shows no free air under the diaphragm (Fig. 1). The abdominal X-ray ( Fig. 2) shows air both on the inside and outside of the bowel wall consistent with free air, also known as the Rigler sign [1]. Additionally, there is a great amount of parahepatic air, outlining the lower liver edge. The Surgery service was consulted immediately for a possible bowel perforation, and the patient was taken to the operating room. Exploratory laparotomy revealed a perforated sigmoid colon. The patient underwent sigmoid colon resection, bowel re-anastomosis, and had an uncomplicated hospital course. She was discharged home in good condition. DiscussionPerforation of the bowel is a well-documented complication of colonoscopy. Recent estimates place perforation rates after a colonoscopy at 1 in 1,400 among all patients who have a colonoscopy [2]. Fortunately, the mortality rate Fig. 1 Upright chest X-ray with no free air under the diaphragm Fig. 2 Abdominal plain X-ray demonstrating two instances of Rigler sign (black arrows) and para-hepatic air (white arrow)

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“…Although few of our procedures were true screening colonoscopies, our detection rate is in keeping with this. [1][2][3]10,11] 5. Complications.…”

Section: Quality Of Bowel Preparation the Asgementioning

confidence: 99%

“…Ongoing audit is necessary to determine whether this problem is persistent and whether a quality improvement programme is necessary to address this. [1][2][3]10,12] The ongoing drive to ensure that training is quantified and standardised across national centres has involved the mandatory keeping of procedural logbooks. However, these logbooks have mostly been manual, and concerns have been raised that they are not standardised.…”

Section: Quality Of Bowel Preparation the Asgementioning

confidence: 99%

An electronic colonoscopy record system enables detailed quality assessment and benchmarking of an endoscopic service

2015

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Background. Competence in colonoscopy, which is a technically difficult procedure, requires adequate exposure to it and the maintenance of a detailed logbook. Without an electronic record this is difficult to achieve. By implementing an electronic medical record system we aimed to perform a detailed quality assessment audit of colonoscopy, to benchmark our results and generate accurate logbooks for individual endoscopists. Methods. We reviewed the prospectively maintained Hybrid Electronic Medical Registry (HEMR). Colonoscopies performed betweenMarch 2013 and March 2014 were reviewed, and for competency, quality metrics were derived from the guidelines of the American Society of Gastroenterology. Results. A total of 843 colonoscopies were performed. Seven hundred and seventy procedures were performed by three staff endoscopists who each performed over the required 150 procedures annually (n=197, 338 and 235). The remaining 73 (8.7%) were performed by other staff. In 105 cases (12.5%), bowel preparation was deemed to be inadequate, which caused the procedure to be abandoned in 34 cases. A total of 64 cases were deemed to be incomplete because of obstructing lesions (n=26), extensive diverticulosis (n=4), technical difficulty (n=31) and patient discomfort (n=3). There were two complications recorded: perforation (n=1) and bleeding (n=1). Conclusions. The HEMR system enabled the audit of experiences with colonoscopy in our institution. Our results are broadly compatible with the international literature and with a number of guidelines. The development of an electronic record system is a major advance, as it enables meaningful benchmarking and the generation of accurate procedural logbooks.

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Colonoscopy perforation rate, mechanisms and outcome: from diagnostic to therapeutic colonoscopy

Abstract: The perforation rate has declined in recent years in relation to more historical series, but there is now an increasing trend as a consequence of advanced interventional endoscopy. Awareness and experience are the only preventive measures that can limit the incidence of perforation.

Cited by 240 publications

References 84 publications

Consensus review of best practice of transanal irrigation in adults

Consensus review of best practice of transanal irrigation in adults

Rigler sign: a subtle finding of pneumoperitoneum

An electronic colonoscopy record system enables detailed quality assessment and benchmarking of an endoscopic service

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