Management of colonoscopic perforations: A systematic review

Hawkins, Alexander T.; Sharp, Kenneth W.; Ford, Molly M.; Muldoon, Roberta L.; Hopkins, Maeve K.; Geiger, Timothy M.

doi:10.1016/j.amjsurg.2017.08.012

Cited by 21 publications

(23 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The sigmoid colon and the rectosigmoid junction are the most common sites of iatrogenic perforation during a diagnostic procedure, because of direct mechanical injury via shearing forces applied by the shaft or tip of the colonoscope during insertion [19,212,213]. Pericolonic adhesions (from previous gynecological surgery or abdominal inflammation) and severe diverticular disease may increase the risk of perforation, particularly when large-caliber instruments and excessive force are used [214,215].…”

Section: Colorectal Iatrogenic Perforationsmentioning

confidence: 99%

Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement – Update 2020

et al. 2020

View full text Add to dashboard Cite

Summary of Recommendations 1 ESGE recommends that each center implements a written policy regarding the management of iatrogenic perforations, including the definition of procedures that carry a higher risk of this complication. This policy should be shared with the radiologists and surgeons at each center. 2 ESGE recommends that in the case of an endoscopically identified perforation, the endoscopist reports its size and location, with an image, and statement of the endoscopic treatment that has been applied. 3 ESGE recommends that symptoms or signs suggestive of iatrogenic perforation after an endoscopic procedure should be rapidly and carefully evaluated and documented with a computed tomography (CT) scan. 4 ESGE recommends that endoscopic closure should be considered depending on the type of the iatrogenic perforation, its size, and the endoscopist expertise available at the center. Switch to carbon dioxide (CO2) endoscopic insufflation, diversion of digestive luminal content, and decompression of tension pneumoperitoneum or pneumothorax should also be performed. 5 ESGE recommends that after endoscopic closure of an iatrogenic perforation, further management should be based on the estimated success of the endoscopic closure and on the general clinical condition of the patient. In the case of no or failed endoscopic closure of an iatrogenic perforation, and in patients whose clinical condition is deteriorating, hospitalization and surgical consultation are recommended.

show abstract

Section: Colorectal Iatrogenic Perforationsmentioning

confidence: 99%

Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement – Update 2020

et al. 2020

View full text Add to dashboard Cite

show abstract

“…24 Moreover, clinical studies have demonstrated the appropriateness of perforation closure with TTSCs. 1,25,26 In a recent meta-analysis, the success rate of endoscopic closure of colon perforations was 83.8% (212 of 253). However, most cases of perforations occurred during therapeutic colonoscopy and most of the perforations were small.…”

Section: Through-the-scope Clipsmentioning

confidence: 99%

Endoscopic Management of Iatrogenic Colon Perforation

Jung¹

2020

Clin Endosc

View full text Add to dashboard Cite

Colon perforations are difficult to resolve because they occur unexpectedly and infrequently. If the clinician is unprepared or lacks training in dealing with perforations, the clinical prognosis will be affected, which can lead to legal issues. We describe here the proper approach to the management of perforations, including deciding on endoscopic or surgical treatment, selection of endoscopic devices, endoscopic closure procedures, and general management of perforations that occur during diagnostic or therapeutic colonoscopy. clin

show abstract

“…Morbidity and mortality rates following iatrogenic perforation are significant. A systematic review by Hawkins et al of data from the last 10 years reported morbidity rates of 14–58% and mortality rates of up 26% . Older age and larger perforation size have been demonstrated as independent mortality risk factors in patients with iatrogenic perforation .…”

Section: Discussionmentioning

confidence: 99%

Treatment of colonoscopic perforation: outcomes from a major single tertiary institution

Chew

Faragher

2019

ANZ Journal of Surgery

View full text Add to dashboard Cite

Background: The use of colonoscopy has been increasing in Australia. This case series describes management and outcomes of colonoscopic perforation managed by a single tertiary referral unit. Methods: An analysis of 13 years (2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015) of prospectively collected data on patients who had a colonoscopic perforation and were managed by the colorectal unit at a single tertiary referral centre was performed. Main outcomes were time of diagnosis, modality of management, time to theatre, length of stay, cost of admission and complications. Results: Sixty-two patients had perforations (median age of 69 years). Thirty-eight (61.2%) patients had their colonoscopy performed in another institution. The incidence rate decreased to 0.37 perforations per 1000 colonoscopies within Western Health. Overall, diagnostic colonoscopies accounted for 56% of perforations and perforations were likely to occur in the left colon (P = 0.006). Fifty-one (82%) patients underwent surgery during their admission, with 24% of these being laparoscopic procedures. An earlier diagnosis was associated with significantly less intra-abdominal contamination. Gross peritoneal contamination was more likely to be associated with the decision to form a stoma (37%, n = 19, P = 0.04). Thirty-day mortality was 1.6% (n = 1). Conclusions: Colonoscopic perforations occur in experienced hands and may have serious implications. We demonstrated a difference in patterns of injury between therapeutic and diagnostic colonoscopies. Those who have an earlier diagnosis are less likely to have severe intra-abdominal contamination requiring a stoma formation.

show abstract

Management of colonoscopic perforations: A systematic review

Cited by 21 publications

References 38 publications

Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement – Update 2020

Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement – Update 2020

Endoscopic Management of Iatrogenic Colon Perforation

Treatment of colonoscopic perforation: outcomes from a major single tertiary institution

Contact Info

Product

Resources

About