Clin Colon Rectal Surg 2018; 31(01): 041-046
DOI: 10.1055/s-0037-1602179
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Colonoscopic Perforations

Vinay Rai
1   Department of Surgery, University of New Mexico, Albuquerque, New Mexico
,
Nitin Mishra
2   Division of Colon and Rectal Surgery, Mayo Clinic College of Medicine, Phoenix, Arizona
› Author Affiliations
Further Information

Publication History

Publication Date:
19 December 2017 (online)

Abstract

Colonoscopy is the gold standard for colon cancer screening. It has led to a decrease in the incidence of colorectal cancer mortality. Colon perforation is a feared complication of this procedure with high morbidity and substantial mortality. Due to the high volume of colonoscopies performed, the absolute number of colonoscopic perforations is relatively high. It leads to a substantial cost to the patient and the health system. Understanding the mechanisms and the risk factors may help in preventing perforation. Traditionally, a laparotomy with creation of a stoma was used to address this complication. However, minimally invasive techniques such as laparoscopy and endoluminal repairs are being used more commonly now. More surgeons are favoring primary anastomosis (with or without a diverting loop ileostomy) than a Hartmann procedure.

 
  • References

  • 1 Wolff WI. Colonoscopy: history and development. Am J Gastroenterol 1989; 84 (09) 1017-1025
  • 2 Seeff LC, Richards TB, Shapiro JA. , et al. How many endoscopies are performed for colorectal cancer screening? Results from CDC's survey of endoscopic capacity. Gastroenterology 2004; 127 (06) 1670-1677
  • 3 Cai SL, Chen T, Yao LQ, Zhong YS. Management of iatrogenic colorectal perforation: from surgery to endoscopy. World J Gastrointest Endosc 2015; 7 (08) 819-823
  • 4 Iqbal CW, Cullinane DC, Schiller HJ, Sawyer MD, Zietlow SP, Farley DR. Surgical management and outcomes of 165 colonoscopic perforations from a single institution. Arch Surg 2008; 143 (07) 701-706 , discussion 706–707
  • 5 Mishra N, Roberts PL, Marcello PW. , et al. Changing paradigms in acute care surgery: a shift to the hindgut. Am Surg 2014; 80 (01) 76-80
  • 6 Fujiya M, Tanaka K, Dokoshi T. , et al. Efficacy and adverse events of EMR and endoscopic submucosal dissection for the treatment of colon neoplasms: a meta-analysis of studies comparing EMR and endoscopic submucosal dissection. Gastrointest Endosc 2015; 81 (03) 583-595
  • 7 Avgerinos DV, Llaguna OH, Lo AY, Leitman IM. Evolving management of colonoscopic perforations. J Gastrointest Surg 2008; 12 (10) 1783-1789
  • 8 Iqbal CW, Chun YS, Farley DR. Colonoscopic perforations: a retrospective review. J Gastrointest Surg 2005; 9 (09) 1229-1235 , discussion 1236
  • 9 Scott-Conner CEH. SpringerLink (Online service), Society of American Gastrointestinal Endoscopic Surgeons. The SAGES manual: fundamentals of laparoscopy, thoracoscopy, and GI endoscopy. 2nd ed. New York: Springer; 2006
  • 10 Bielawska B, Day AG, Lieberman DA, Hookey LC. Risk factors for early colonoscopic perforation include non-gastroenterologist endoscopists: a multivariable analysis. Clin Gastroenterol Hepatol 2014; 12 (01) 85-92
  • 11 Arora G, Mannalithara A, Singh G, Gerson LB, Triadafilopoulos G. Risk of perforation from a colonoscopy in adults: a large population-based study. Gastrointest Endosc 2009; 69 (3, Pt 2): 654-664
  • 12 Chukmaitov A, Bradley CJ, Dahman B, Siangphoe U, Warren JL, Klabunde CN. Association of polypectomy techniques, endoscopist volume, and facility type with colonoscopy complications. Gastrointest Endosc 2013; 77 (03) 436-446
  • 13 Doran H, Marin IT, Iaciu M, Pătraşcu T. Iatrogenic perforations during colonoscopy. Chirurgia (Bucur) 2014; 109 (04) 523-526
  • 14 Garrett KA, Church J. History of hysterectomy: a significant problem for colonoscopists that is not present in patients who have had sigmoid colectomy. Dis Colon Rectum 2010; 53 (07) 1055-1060
  • 15 Navaneethan U, Kochhar G, Phull H. , et al. Severe disease on endoscopy and steroid use increase the risk for bowel perforation during colonoscopy in inflammatory bowel disease patients. J Crohn's Colitis 2012; 6 (04) 470-475
  • 16 Lohsiriwat V. Colonoscopic perforation: incidence, risk factors, management and outcome. World J Gastroenterol 2010; 16 (04) 425-430
  • 17 Wexner SD, Forde KA, Sellers G. , et al. How well can surgeons perform colonoscopy?. Surg Endosc 1998; 12 (12) 1410-1414
  • 18 Adeyemo A, Bannazadeh M, Riggs T, Shellnut J, Barkel D, Wasvary H. Does sedation type affect colonoscopy perforation rates?. Dis Colon Rectum 2014; 57 (01) 110-114
  • 19 Hansen JJ, Ulmer BJ, Rex DK. Technical performance of colonoscopy in patients sedated with nurse-administered propofol. Am J Gastroenterol 2004; 99 (01) 52-56
  • 20 Kim HH, Kye BH, Kim HJ, Cho HM. Prompt management is most important for colonic perforation after colonoscopy. Ann Coloproctol 2014; 30 (05) 228-231
  • 21 Hirasawa K, Sato C, Makazu M. , et al. Coagulation syndrome: Delayed perforation after colorectal endoscopic treatments. World J Gastrointest Endosc 2015; 7 (12) 1055-1061
  • 22 Cha JM, Lim KS, Lee SH. , et al. Clinical outcomes and risk factors of post-polypectomy coagulation syndrome: a multicenter, retrospective, case-control study. Endoscopy 2013; 45 (03) 202-207
  • 23 An SB, Shin DW, Kim JY, Park SG, Lee BH, Kim JW. Decision-making in the management of colonoscopic perforation: a multicentre retrospective study. Surg Endosc 2016; 30 (07) 2914-2921
  • 24 Damore II LJ, Rantis PC, Vernava III AM, Longo WE. Colonoscopic perforations. Etiology, diagnosis, and management. Dis Colon Rectum 1996; 39 (11) 1308-1314
  • 25 Castellví J, Pi F, Sueiras A. , et al. Colonoscopic perforation: useful parameters for early diagnosis and conservative treatment. Int J Colorectal Dis 2011; 26 (09) 1183-1190
  • 26 Kantsevoy SV, Bitner M, Hajiyeva G. , et al. Endoscopic management of colonic perforations: clips versus suturing closure (with videos). Gastrointest Endosc 2016; 84 (03) 487-493
  • 27 Makarawo TP, Damadi A, Mittal VK, Itawi E, Rana G. Colonoscopic perforation management by laparoendoscopy: an algorithm. JSLS 2014; 18 (01) 20-27
  • 28 Rotholtz NA, Laporte M, Lencinas S, Bun M, Canelas A, Mezzadri N. Laparoscopic approach to colonic perforation due to colonoscopy. World J Surg 2010; 34 (08) 1949-1953
  • 29 Farley DR, Bannon MP, Zietlow SP, Pemberton JH, Ilstrup DM, Larson DR. Management of colonoscopic perforations. Mayo Clin Proc 1997; 72 (08) 729-733
  • 30 Teoh AY, Poon CM, Lee JF. , et al. Outcomes and predictors of mortality and stoma formation in surgical management of colonoscopic perforations: a multicenter review. Arch Surg 2009; 144 (01) 9-13