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Hospital management of colonic perforations complicating ambulatory outpatient colonoscopy via over-the-scope clips or surgery: a case series

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Abstract

Background

Colonoscopy is the standard of care for the diagnosis and treatment of many colonic disorders. Over the past few years, endoscopic closure of colonoscopy-related perforation has become more common. Endoscopic closure of perforation secondary to colonoscopy has been undertaken in patients in the hospital setting and often during the same colonoscopic procedure in which the perforation itself occurred. The aim of our study was to analyze our experience with emergency endoscopic closure of colonoscopy-related perforation with over-the-scope clip (OTSC) technique.

Methods

We report five cases of colonic perforation that occurred during colonoscopy in an outpatient facility remotely located from our hospital and then referred as an emergency to our institution for endoscopic closure.

Results

Bowel preparation was reported to be adequate in all cases. Prior to attempting endoscopic closure of colonic perforation, all patients were in stable clinical condition, early broad-spectrum antibiotic coverage was initiated, and a surgical consult was obtained. All patients had sigmoidoscopy and were found to have sigmoid colon perforations. In three cases, the perforations were closed successfully using an OTSC clip device 14 mm type t. Two patients were found to have greater than 4-cm sigmoid perforations with irregular margins, incompatible with OTSC closure, and were referred for emergency surgery. All patients had an uneventful course following either OTSC closure or surgery.

Conclusions

Based on the characteristics of the five cases and a review of the literature, we suggest a practical approach for undertaking closure of colonic perforations occurring during colonoscopy in the outpatient setting, focusing on clinical criteria to determine eligibility of patients for attempted endoscopic closure and outlining required therapeutic and monitoring steps needed to optimize outcomes.

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Author notes

  1. S. Daher and T. Khoury contributed equally.

Authors and Affiliations

  1. Division of Medicine, Institute of Gastroenterology and Liver Disease, Hadassah-Hebrew University Medical Center, P.O.B. 12000, 91120, Jerusalem, Israel

    S. Daher, T. Khoury, A. A. Benson, E. Tsvang & H. Jacob

  2. Department of General Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel

    R. Elazary

  3. Department of Gastroenterology, Galilee Medical Center, Nahariya, Israel

    T. Khoury

  4. Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel

    T. Khoury

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  1. S. Daher
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  2. T. Khoury
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  3. A. A. Benson
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  4. E. Tsvang
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  5. R. Elazary
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  6. H. Jacob
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Contributions

SD and TK contributed to concept, review of literature, drafting of the manuscript and approval of the final manuscript. AAB, ET and RE contributed to technical support, critical revision of the manuscript. HJ: concept, technical support, and critical revision of the manuscript.

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Correspondence to T. Khoury.

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The authors declare no conflict of interest regarding this manuscript.

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The study was approved by the local institutional ethic committee.

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Written informed consent was obtained from all participants.

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Daher, S., Khoury, T., Benson, A.A. et al. Hospital management of colonic perforations complicating ambulatory outpatient colonoscopy via over-the-scope clips or surgery: a case series. Tech Coloproctol 23, 681–685 (2019). https://doi.org/10.1007/s10151-019-02045-3

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  • DOI: https://doi.org/10.1007/s10151-019-02045-3

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