Editorial comment on: ‘Colonoscopic perforations: Single center experience and review of the literature’

Abstract

We read the article on "Colonoscopic perforations: Single center experience and review of the literature" by Çolak et al. (1) with great interest.Colonoscopy is the most effective diagnostic method for colorectal lesions because it allows direct visualization of the colorectal mucosa, it is also the standard procedure for colorectal cancer screening (2). Since early recognition and removal of colorectal polyps are very important in the prevention of colorectal cancer, the use of colonoscopy has increased over the years. Although colonoscopy is a safe procedure, fatal complications such as perforation or bleeding may occur during the procedure. The authors presented their clinical experience on colonoscopic perforation, one of the most serious complications of colonoscopy, in the light of the literature. First, we believe that the addition of some parameters such as ASA score, body mass index, history of abdominal surgery, colonoscopy indications (polypectomy, screening, gastrointestinal symptoms), detected colorectal pathology, time to diagnosis (during colonoscopy, delayed), peritoneal findings, leukocytosis, management (operative, non-operative) and length of hospital stay (day) of the patients into Table 2 that described the demographic characteristics, localization, diagnosis and treatment of patients with colonoscopic perforation will enlighten readers.In the material-methods section, the authors stated that they applied "radiological examination" for diagnosis, but they only presented X-ray results in the results part. We are of the opinion that clarifying whether abdominal computerized tomography (CT) was applied (especially in patients with peritoneal irritation findings) and describing CT findings (a CT imagemay be added) if available, will strengthen the article.Although the title of the article is about colonoscopic perforation, the authors grouped perforations of colonoscopy and rectosigmoidoscopy (RSS) separately in their study (Table 1). We think that the RSS information will not provide an additional contribution to the readers. Likewise, perforation occuring during RSS leads to a question mark in the reader's mind. We also think that it would be useful to clarify the specialty of the endoscopist (surgeon or gastroenterologist) in case of colonoscopic perforation.The authors declared that "ethics committee approval was not required due to the retrospective nature of the study" in the material-methods section. On the other hand, due to the current legislation and the scientific using of the information of the patients, it is necessary to obtain approval of the ethics committee in all studies that do not require the direct intervention of a physician such as all observational studies, survey studies, retrospective archive scans for file or image records. In this regard, we believe that it would be appropriate to correct the disclosure in order not to mislead the readers.The authors did not specify the ASA scores of the study group, although they emphasized "the findings from our study showed that pa...