Managing perforations in colonoscopies detected by our endoscopy unit in an intraprocedural manner. A descriptive study

Aims Perforations are one of the most relevant complications of colonoscopies. Albeit infrequent, they show an important morbimortality rate.

An incidence of 0.1-0.8% (up to 8% in therapeutic colonoscopy) and a mortality rate of 5-25% have been reported.

Devices allowing endoscopic closure of perforations are now available: through-the-scope clips and over-the-scope devices, which aim to avoid surgery.

Assessing perforation risk factors, endoscopic treatment effectiveness and subsequent clinical evolution.

Methods Descriptive and retrospective study, including patients whose intraprocedural endoscopic perforation was detected between January/2015 and December/2022.

Epidemiological, clinical and endoscopic variables were collected.

Technical success was defined as achieving a correct intraprocedural endoscopic closure in the same act, while clinical success was defined as not needing subsequent surgery.

Results 15 perforations were detected in an intraprocedural manner and 2 after reintroducing the endoscopy due to abdominal pain in the recovery room. Average age was 75.52 years with female predominance (58.82%). 76.47% presented a≥3 Charlson index.

Endoscopic management was initially attempted in 88.23% (15) of the cases, with 40% using hemoclips and 60% using "over-the-scope" devices (13.33% Ovesco and 46.67% Padlock, regarding the total). The remaining 2 cases underwent surgery.

Technical success was achieved in 86.67%. Rescue surgery was required in 1 case after failing to adequately place an Ovesco. In the other case, placement of a Padlock was unsuccessfully attempted, limiting the therapeutic effort due to advanced neoplastic disease.

Regarding risk factors, 35.29% had diverticula and 52.94% had received abdominal surgery.

All data related to place and cause of perforation is shown in Figures 1 and 2. We can observe that ascending colon and mucosectomy are the most frequent, respectively.

A total of 9 (52.94%) polypectomies were performed. Data are shown in Figure 3.

There were 2 exitus (11.76%), both due to advanced neoplastic disease.

The average length of hospitalization was 9.26 days.

Conclusions Our study shows that the main risk factor for perforation is mucosectomy, mainly in the ascending colon. Other risk factors such as previous abdominal surgery, diverticula, or high comorbidity should be considered. [1] [2] [3]

If the perforation is detected in an intraprocedural manner, endoscopic closure is safe and effective; perforation closure is achieved in most cases and should always be attempted.

It is necessary to maintain a high diagnostic suspicion, especially in cases with higher risk, either due to the technique performed or the patient's profile.

Larger studies are needed to verify our results.

 

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Conflicts of interest

Authors do not have any conflict of interest to disclose.

• References

• 1 Lüning TH, Keemers-Gels ME, Barendregt WB, Tan AC, Rosman C.. Colonoscopic perforations: a review of 30,366 patients. Surg Endosc 2007; 21 (06) 994-7
• 2 Recognition and Management of Colonic Perforation following Endoscopy
• 3 Rai V, Mishra N.. Colonoscopic Perforations. Clin Colon Rectal Surg 2018; 31 (01) 41-46

Publikationsverlauf

Artikel online veröffentlicht:
15. April 2024