Complications in endoscopy of the lower gastrointestinal tract

Jentschura, D.; Raute, M.; Winter, Joost de; Henkel, Th.; Kraus, M.; Manegold, B. C.

doi:10.1007/bf00678564

Cited by 176 publications

(79 citation statements)

References 9 publications

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“…The current literature reports mortality rates of 0% to 50% [12]. The hospital mortality rate in the current study was 8.6%.…”

Section: Discussionsupporting

confidence: 42%

“…Colonic perforation resulting from colonoscopic and sigmoidoscopic procedures is a rare but serious complication with high rates of morbidity and mortality [1,3,6,7,12]. The frequency of perforations after colonoscopy is estimated to be 0.03% to 0.8% for diagnostic colonoscopy and 0.15% to 3% for therapeutic colonoscopy [22].…”

Section: Abstract: Colon Perforation -Colonoscopycomplication -Endosmentioning

confidence: 99%

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Colonoscopic perforations: a review of 30,366 patients

et al. 2007

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Background: Although the incidence of perforation after endoscopic procedures of the colon is low, the rising number of procedures could pose relevant health problems. Recognizing risk factors and optimizing treatment may reduce perforation incidence and the probability of (severe) complications. This study aimed to determine perforation frequency and the management of endoscopic colonoscopic perforation. Methods: A retrospective review of patient records was performed for all patients with iatrogenic colonic perforations after sigmoido/colonoscopy between 1990 and 2005. The patientsÕ demographic data, endoscopic procedural information, perforation location, therapy, and outcome were recorded. Results: In the 16-year period, 30,366 endoscopic colonic procedures were performed. In total, 35 colonic perforations occured (0.12%). All the patients underwent a laparotomy: for primary repair in 18 cases (56%), for resection with anastomosis in 8 cases (25%), and for resection without anastomosis in 6 cases (19%). In three patients (8.6%), no perforation was found. The postoperative course was uncomplicated in 21 cases (60%) and complicated in 14 cases (40%), including mortality for 3 patients (8.6% resulting from perforations and 0.01% resulting from total endoscopic colon procedures). The relative risk ratio of colonoscopic and sigmoidoscopic procedures for perforations was 4. Therapeutic procedures show a delay in presentation and diagnosis compared with diagnostic procedures. Of the 35 perforations, 26 (74%) occurred in the sigmoid colon. Conclusion: Iatrogenic colonic perforation is a serious but rare complication of colonoscopy. A perforation risk of 0.12% was found. The perforation risk was higher for colonoscopic procedures than for sigmoidoscopic procedures. The sigmoid colon is the area at greatest risk for perforation. Immediate operative management, preferably primary repair and sometimes resection, appears to be a good strategy for most patients. Key words: Colon perforation -ColonoscopyComplication -Endoscopy -IatrogenicColonic perforation resulting from colonoscopic and sigmoidoscopic procedures is a rare but serious complication with high rates of morbidity and mortality [1,3,6,7,12]. The frequency of perforations after colonoscopy is estimated to be 0.03% to 0.8% for diagnostic colonoscopy and 0.15% to 3% for therapeutic colonoscopy [22]. With increasing numbers of colonoscopies being performed for screening purposes, this small possibility of perforations still may cause a high number of clinical problems. The optimal treatment for perforations, whether conservative or operative, still is unclear because no randomized trial has ever been conducted.Recent studies are acquiring evidence for laparoscopic and endoluminal repair using clips for perforation closure [15-17, 19, 22]. Knowing risk factors, recognizing early signs of perforation, and giving early and optimal treatment may reduce the probability of (severe) complications and death from iatrogenic colon perforations. In this report, we re...

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“…The current literature reports mortality rates of 0% to 50% [12]. The hospital mortality rate in the current study was 8.6%.…”

Section: Discussionsupporting

confidence: 42%

Section: Abstract: Colon Perforation -Colonoscopycomplication -Endosmentioning

confidence: 99%

Colonoscopic perforations: a review of 30,366 patients

et al. 2007

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“…For example, a study by the American Society for Gastrointestinal Endoscopy involving 25,000 diagnostic colonoscopies reported a complication rate of 0.35%. 4 In another large study, Jentscura et al 5 reported an overall complication rate of 0.4% in 26,695 prospectively registered colonoscopies. The most common complications in adult patients are hemorrhage, preparation-associated complications, adverse effects of sedative medicines, perforation, and bacteremia.…”

Section: Discussionmentioning

confidence: 97%

Complications of Pediatric Colonoscopy: A Five-Year Multicenter Experience

Thakkar

El–Serag

Mattek

et al. 2008

Clinical Gastroenterology and Hepatology

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Colonoscopy has become a routine modality for the evaluation and treatment of colonic disorders in children. Although generally considered a safe procedure, colonoscopy has the potential for complications. Most informed consent forms describe adverse effects of sedative medicines, perforation, infection, and bleeding as possible risks of colonoscopy. However, the frequency of these complications remains unclear. There are limited pediatric data showing complication rates, and most prior studies involved small numbers of procedures. Furthermore, there might be additional complications that need to be added to consent protocols, because most current complication data are extrapolated from the much larger experience in adult populations.A review of pediatric literature demonstrated a wide array of potential complications and no large multicenter studies during the past 25 years. The largest study was conducted in [1978][1979] and included a survey of 1400 proctosigmoidoscopies performed during an 18-month period at 25 medical centers in the U.S. 1 This study was only published in abstract form and reported complications in 0.2% of all colonoscopy procedures. These complications included one hemorrhage requiring transfusion and one perforation. In the second largest study, Stringer et al 2 prospectively described a series of 250 flexible colonoscopies done in the United Kingdom during a 3.5-year period with no adverse events. Several other studies reported complications (Table 1) in pediatric colonoscopy, but the majority of these studies examined a small number of procedures.Determination of potential colonoscopy-related complications and their expected frequency in children can lead to enhanced risk-benefit analysis by physicians and patients and improved informed consent. There is a lack of systematic, multicenter studies in the pediatric population. Therefore, we conducted the current study to examine the frequency, type, and clinical determinants of immediate complications encountered during pediatric Address requests for reprints to: Kalpesh Thakkar, MD, 6621 Fannin St CCC 1010, Houston, TX 77030. kthakkar@bcm.tmc.edu; fax: 832-825-3633. Simple logistic regression was used to estimate the crude risk of cardiopulmonary events and gastrointestinal bleeding for variables that were identified as significantly associated with the outcomes during categorical analysis (P < .05). Multiple logistic regression models included all variables determined significant on univariate analysis. In constructing the models, we followed the commonly used heuristic of 10 outcome events for each explanatory variable. The adjusted risks estimate for each independent predictor variable was expressed as odds ratios. All analyses were performed by using SAS software (SAS Institute, Inc, Cary, NC). HHS Public Access ResultsDuring the study period, 8841 colonoscopies were recorded at 12 PEDS-CORI sites, and 1049 (11.9%) were excluded for incomplete procedure notes, duplicate records, or patient age older than 18 years. Thus, a total of 77...

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“…In this study 87% of the patients suffered from multiple organ diseases such as heart disease, encephalopathy, and nephrosis, and 24.3% of them had diseases in more than 3 vital organs, but the incidence of complication was significantly lower than that (0.4-1.4%) [29][30][31] with no occurrence of death and perforation [31] as a result of the improvement of intestinal canal preparation, simplification of colonoscopy intubation, and the appropriate measures taken for them according to the changes of their blood pressure and ECG when colonoscopy was performed. 29.2% of the patients in this study had a history of abdominal operation, but the successful rate of intubation was 98.9%.…”

Section: Discussionmentioning

confidence: 60%

Colonoscopic screening and follow-up for colorectal cancer in the elderly

Wan¹,

Zhang²,

Zhu³

et al. 2002

WJG

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AIM: To improve the prevention and treatment of senile patients with colorectal cancer by evaluating the importance of colonoscopy in clinical screening and follow-up.METHODS: Clinical screening of colonoscopy was performed for 2196 patients aged 60-90 years old according to the protocol,and 1740 of them (79.2%) were followed-up. RESULTS:Colorectal cancer was found in 52 patients, and the detectable rate was 2.4%. Among them, 19 were diagnosed as early colorectal cancer, accounting for 36.5% of the detected colorectal cancer. Among the followed-up patients, early colorectal cancer was found in 9, accounting for 45.0% of the detected colorectal cancer. The resectable rate and 5 years survival rate of colorectal cancer were 97.7% and 80.9% respectively. The incidence of complication was 0.05%, and the successful rate of cecum intubation was 98.9%. CONCLUSION:Colonoscopic screening and follow-up of the elderly for colorectal cancer and pre-cancerous lesion (adenomatoid polyp) can increase the detectable rate of early colorectal cancer and improve its prevention and treatment.

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Complications in endoscopy of the lower gastrointestinal tract

Cited by 176 publications

References 9 publications

Colonoscopic perforations: a review of 30,366 patients

Colonoscopic perforations: a review of 30,366 patients

Complications of Pediatric Colonoscopy: A Five-Year Multicenter Experience

Colonoscopic screening and follow-up for colorectal cancer in the elderly

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