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Background: The colonoscope has become a standard tool for diagnosing and treating pathological diseases of the colon. Colonoscopic perforation is one of the serious consequences associated with colonoscopy, and as a result, it may result in a high rate of morbidity and mortality. Objectives: This study aims to determine the incidence and risk factors associated with colonoscopic perforation in a training institution. Methods: A retrospective review of medical records was performed for patients undergoing colonoscopy in Rajavithi Hospital between 2009 and 2019, total 10.057 patient. The patient's demographic data, indication for colonoscopy, quality of bowel preparation, endoscopic procedure, perforation, and diagnostic were recorded. Results: Between 2009 and 2019, 12,239 colonoscope was performed and 2,182 colonoscopy was excluded. In total 0.71% (71/10,057) colonoscopic perforation was occurred. Multivariate logistic regression analysis reveals that previous gynecologic surgery (OR 41.1, p-value < 0.001, 95% CI 16.40-102.73), general anesthesia (OR 7.74, p-value 0.016, 95% CI 1.46-40.97), trainee (OR 20.74, p-value < 0.001, 95% CI 11.25-38.35) and polypectomy (OR 6.08, p-value < 0.001, 95% CI 3.15-11.70), EMR (OR 23.32, p-value < 0.001, 95% CI 6.02-90.41) and endoscopic subepithelial dissection (OR 89.99, p-value < 0.001, 95% CI 12.74-135.46) were significant. Conclusion: Patients tend to have a higher colonoscopic perforation rate when they have a history of previous gynecological surgery or general anesthesia the colonoscopy to be performed by a trainee or polypectomy or endoscopic submucosal resection (EMR) or endoscopic submucosal dissection (ESD) to be performed. Even though we're aware of the risk factor, we must nevertheless handle each case with care and solely focus on high-risk populations in our practice. [ABSTRACT FROM AUTHOR]

Introduction: Colonoscopy is widely used for diagnostic and therapeutic purposes in colon, rectum, and anal canal diseases. Although colonoscopic perforations are rare, they can lead to serious morbidity and mortality. The aim of this study was to examine the diagnosis, treatment, and follow-up results of the patients operated for colonoscopic perforation in the light of the literature. Methods: The results of the patients, who were operated in our clinic with the diagnosis of colonoscopic perforation between January 2015 and November 2019, were evaluated retrospectively. The patients’ demographic characteristics, colonoscopy findings, disease diagnoses, time of surgery, and surgery performed and follow-up results were analyzed. Results: A total of 7802 colonoscopy procedures were performed. Ten patients (0.12%) developed colonoscopic perforation. Of the patients, 6 (60%) were female and 4 (40%) were male. The mean age was 71.5 years. Perforation developed during the diagnostic procedure in 7 patients (70%) and during polypectomy in 3 patients (30%). Perforation localization was the sigmoid colon in seven patients, the rectosigmoid junction in two patients, and the right colon in one patient. All patients were operated within 6 h after the procedure. Six patients underwent primary repair, three patients underwent segmental colon resection + end-to-end anastomosis, and one patient underwent multiple surgeries. While two patients developed minor complications, one patient died on the 6th day after the procedure due to intra-abdominal sepsis. Discussion and Conclusion: Although the incidence of colonoscopic perforation is low, it causes serious morbidity and mortality when it develops. Patients and their relatives should be informed in detail about possible complications before colonoscopy. Although there is no gold standard treatment, we believe that the diagnosis should be made as early as possible and appropriate treatment should be performed without delay. [ABSTRACT FROM AUTHOR]

Introduction: Colonoscopy is a tool for screening colorectal cancer, but colonoscopic perforation (CP), though rare, is of concern, because of its high morbidity and mortality. The objective of the present study is to determine the incidence, risk factors, management, outcome, and mortality rate of CP at a tertiary care hospital. Methods: The present retrospective study included patients who underwent colonoscopy from January 1, 2009, to January 1, 2020 at the authors’ institution. Management of patients with colonoscopic perforation were categorized into two groups according to therapeutic modality: the operative (surgery) and non-operative (endoscopic management or conservative treatment) groups. Results: There were 71 patients with CP. Of these, 19 received endoscopic management. Endoscopic management failure occurred in 8 patients, and 60 patients underwent laparotomy after diagnosis. Segmental bowel resection with primary anastomosis was done in 37 patients. Leakage of anastomosis occurred in 3 patients. The average time to diagnosis was 9.73 ± 16.87 hours (range, 1 to 96 hours), the average time to operation after diagnosis was 6.98 ± 4.91 hours (range,1 to 24 hours). The mortality rate was 7%. Factors associated with mortality were time to diagnosis and type of operation (p = 0.003 and p = 0.012, respectively). The average hospital stay was 10.90 ± 7.96 days (range, 3 to 45 days). Conclusion: The time to diagnosis and the injury mechanism are major factors in the choice of management. Nonoperative management is beneficial and feasible for colonoscopic perforation with early detection. [ABSTRACT FROM AUTHOR]

Background: There are few studies on postoperative complications after colonoscopic perforation. We aimed to study clinical characteristics and treatment after colonoscopic perforation, and to determine risk factors for postoperative complications by surgical treatment of colonoscopy perforation. Methods: Cases with perforation within 7 days after colonoscopy from January 2017 to December 2019 were collected for retrospective analysis. Data regarding demography, clinical information, colonoscopy, perforation, and operation were collected. Single-factor analysis and Spearman correlation analysis were employed to determine the risk factors of postoperative complications. Results: A total of 35,243 colonoscopy examinations were performed during the study period, of which 18 cases of colonoscopic perforation were included in the criteria. Most perforations occurred in the rectosigmoid junction (3 cases) and sigmoid colon (11 cases). All perforation patients received operational treatment, and the incidence of postoperative complications was 38.9%, but no deaths. There were 7 patients who developed postoperative complications. Spearman correlation analysis showed that preoperative medication of glucocorticoid and nonrectosigmoid perforation were positively related to postoperative complications (P < .05), while perforation diagnosed immediately and satisfying intestinal cleanliness were negatively related to it (P < .05). Conclusion: Perforation is a rare but serious complication of colonoscopy, which mostly occurs in the rectosigmoid junction and sigmoid colon. Laparoscopic primary repair is safe and feasible in resolving colonic perforation due to colonoscopy, and postoperative complications were significantly related to perforation site, preoperative medication of glucocorticoid, perforation diagnosis time, and intestinal cleanliness. [ABSTRACT FROM AUTHOR]

Background: The aim of this review is to evaluate and summarize the current strategies used in the management of colonoscopic perforations as well as propose a modern treatment algorithm.Methods: Articles published between January 2004 and January 2019 were screened. A total of 167 reports were identified in combined literature search, of which 61 articles were selected after exclusion of duplicate and unrelated articles. Only studies that reported on the management of endoscopic perforation in an adult population were retrieved for review. Case reports and case series of 8 patients or less were not considered. Ultimately, 19 articles were considered eligible for review.Results: A total of 744 cases of colonoscopic perforations were reported in 19 major articles. The cause of perforation was mentioned in 16 articles. Colonoscopic perforations were reported as a consequence of diagnostic colonoscopies in 222 cases and therapeutic colonoscopies in 248 cases. The site of perforation was mentioned in 486 cases. Sigmoid colon was the predominant site followed by the cecum. The management of colonoscopic perforations was reported in a total of 741 patients. Surgical intervention was employed in 75% of the patients, of these 15% were laparoscopic and 85% required laparotomy. The predominant surgical intervention was primary repair.Conclusion: Management strategies of colon perforations depend upon the etiology, size, severity, location, available expertise, and general health status. Usually, peritonitis, sepsis, or hemodynamic compromise requires immediate surgical management. Endoscopic techniques are under continuous evolution. Newer developments have offered high success rate with least amount of post-procedure complications. However, there is a need for further studies to compare the newer endoscopic techniques in terms of success rate, cost, complications, and the affected part of colon. [ABSTRACT FROM AUTHOR]

Background/Aims: Colonoscopic perforations have been managed with exploratory laparotomy, and have resulted in some morbidity and mortality. Recently, laparoscopic surgery is commonly performed for this purpose. The aim of this study was to compare the outcomes of several management strategies for iatrogenic colonoscopic perforations. Methods: We retrospectively reviewed the medical records of patients who had been treated for colonoscopic perforation between January 2004 and April 2013 at CHA Bundang Medical Center in Korea. Results: A total of 41 patients with colonoscopic perforation were enrolled. Twenty patients underwent conservative management with a success rate of 90%. Surgical management was performed in 23 patients including two patients who were converted to surgical management after the failure of the initial conservative management. Among 14 patients who underwent surgery at 8 hours after the perforation, there was no considerable difference in adverse outcomes between the laparotomy group and the laparoscopic surgery group. The medical costs and claim rate were 1.45 and 1.87 times greater in the exploratory laparotomy group, respectively. Conclusions: Conservative management of colonoscopic perforation could be an option for patients without overt symptoms of peritonitis or with a small defect size. If surgical management is required, laparoscopic surgery may be considered as the initial procedure even with a delayed diagnosis.

Objective: Our aim in this study was to present the cases of our patients who contracted colonic perforation during elective colonoscopy and became emergency cases; we also discuss treatment modalities along with literature reports on the subject. Material and Methods: Cases of patients who contracted iatrogenic colonic perforation following endoscopy of the colorectal system between January 2009 and December 2015 at Kartal Koşuyolu Yüksek İhtisas Training and Research Hospital's Endoscopy Unit were reviewed retrospectively. Results: Within the duration of the study, 5.586 patients underwent colonoscopies at our hospital; 7 (0.12%) of these patients contracted iatrogenic colonic perforation. Three (42.8%) of these patients were male, four (57.2%) were female, and their mean age was 69 years (46 to 84). Six (85.7%) patients were diagnosed intraoperationally, while one (14.3%) patient was diagnosed 12 hours after the procedure. The perforation area was the sigmoid colon in six patients and the ascending colon in one patient; all patients underwent surgery. Four patients were discharged with no complications. One of the remaining three patients had enterocutaneous fistula, one had acute renal failure, and one died of sepsis. Conclusion: The progress of perforation due to colonoscopy varies according to the underlying diseases, the mechanism of perforation formation, the treatment modality used, and the experience of the physicians treating the patient. Special attention should be paid to senior and comorbid patients receiving therapeutic procedures during colonoscopy. [ABSTRACT FROM AUTHOR]

Colonoscopy is widely used for the diagnosis, treatment and a follow up of colorectal diseases. Perforation of the large bowel during elective colonoscopy is rare but serious life threatening complication. We report a 51-year-old woman who experienced recto sigmoid perforation during diagnostic colonoscopy. During 8 days of total hospitalization, she spent 3 days in ICU with gastrointestinal rest. The patient was hydrated and took intravenous antibiotics. In take-output and temperature were closely monitored. Serial abdominal examinations were performed to rule out peritonitis. After transferring to surgery ward in the day 4, liquid diet started slowly, and she was ambulated. At the day 8, she was discharged with the good clinical condition. Conservative management of the patients with early diagnosis of perforation and no signs and symptoms of peritonitis or sepsis could be the modality of choice.

Aims: Iatrogenic colonoscopy perforations (ICP) are a rare but severe complication of diagnostic and therapeutic colonoscopies. The present systematic review and meta-analysis aims to investigate the operative and post-operative outcomes of laparoscopy vs. open surgery performed for the management of ICP. Methods: A literature search was carried out on Medline, EMBASE, and Scopus databases from January 1990 to June 2016. Clinical studies comparing the outcomes of laparoscopic and open surgical procedures for the treatment for ICP were retrieved and analyzed. Results: A total of 6 retrospective studies were selected, including 161 patients with ICP who underwent surgery. Laparoscopy was used in 55% of the patients, with a conversion rate of 10%. The meta-analysis shows that the laparoscopic approach was associated with significantly fewer post-operative complications compared to open surgery (18.2% vs. 53.5% respectively; Relative risk, RR: 0.32 [95%CI: 0.19-0.54; p < 0.0001; I² = 0%]) and shorter hospital stay (mean difference -5.35 days [95%CI: -6.94 to -3.76; p < 0.00001; I² = 0%]). No differences between the two surgical approaches were observed for postoperative mortality, need of re-intervention, and operative time. Conclusion: The present study highlights the outcomes of the surgical management of an endoscopic complication that is not yet considered in clinical guidelines. Based on the current available literature, the laparoscopic approach appears to provide better outcomes in terms of postoperative complications and length of hospital stay than open surgery in the case of ICP surgical repair. However, the creation of large prospective registries of patients with ICP would be a step forward in addressing the lack of evidence concerning the surgical treatment of this endoscopic complication. [ABSTRACT FROM AUTHOR]

Colonoscopy is widely used for the diagnosis, treatment and a follow up of colorectal diseases. Perforation of the large bowel during elective colonoscopy is rare but serious life threatening complication. We report a 51-year-old woman who experienced recto sigmoid perforation during diagnostic colonoscopy. During 8 days of total hospitalization, she spent 3 days in ICU with gastrointestinal rest. The patient was hydrated and took intravenous antibiotics. In take-output and temperature were closely monitored. Serial abdominal examinations were performed to rule out peritonitis. After transferring to surgery ward in the day 4, liquid diet started slowly, and she was ambulated. At the day 8, she was discharged with the good clinical condition. Conservative management of the patients with early diagnosis of perforation and no signs and symptoms of peritonitis or sepsis could be the modality of choice. [ABSTRACT FROM AUTHOR]

Objective. Nurse Administered Propofol Sedation (NAPS) contributes to a deeper sedation of the patients, making them unable to respond to pain and an increased incidence of perforations has been speculated. The objective of this study was to evaluate the risk of perforations during colonoscopies performed with either NAPS or conventional sedation regimes. Material and methods. Data were retrospectively retracted from medical journals from 1 January 2007 to 31 December 2011. All journals were examined and cross-referenced to reveal any perforations. We analyzed all colonoscopies in regard to nature of the procedure (diagnostic vs therapeutic), experience of the endoscopist and ASA-classification of the patients. Results. A total of 6371 colonoscopies were performed, of which 3155 were performed under propofol sedation. There were 16 perforations (0.25%); 10 of these performed during NAPS and 6 during conventional colonoscopy ( p = 0.454, OR: 1.7 (95% CI: 0.6-5.7)). There were 4874 diagnostic and 1497 therapeutic colonoscopies, with a majority of the perforations (94%) occurring during a diagnostic procedure ( p = 0.389). No statistically difference was found in the incidence of perforations caused by an experienced or less experienced endoscopist ( p = 0.589). Conclusion. The risk of colonic perforations during colonoscopy was not found to be significantly higher in patients undergoing NAPS compared to patients undergoing conventional sedation, although a tendency may exist. Furthermore, we found no correlation to neither experience of the endoscopist, nature of the procedure nor sex of the patients. Larger and prospective studies are needed to further evaluate on this subject. [ABSTRACT FROM AUTHOR]

Abstract: Background: Endoscopy has assumed a significant role in the management of gastrointestinal disorders. However, endoscopic-related injuries are poorly reported. Methods: Review of our surgical database (1980-2006) identified all patients age 18 years or younger with an endoscopic-related injury managed at our institution. Results: A total of 3269 colonoscopies were performed; there were 3 iatrogenic perforations (incidence, 0.09%). All were managed operatively: 2 underwent fecal diversion, and 1 was repaired primarily. There was 1 postoperative complication (internal hernia) and no deaths related to colonoscopic perforation. Nine thousand three hundred eight esophagogastroduodenoscopy (EGD) procedures were performed, resulting in 6 iatrogenic injuries (0.06%): bleeding (2), perforation (2), and mucosal tears (2) (0.02% each). All EGD-related injuries occurred in the esophagus except for 1 duodenal perforation which was managed operatively by primary repair. Both patients with bleeding complications underwent repeat endoscopy and cautery with satisfactory results. The other 3 patients were managed conservatively without complication. Three hundred eighty-nine endoscopic retrograde cholangiopancreatogram procedures were performed with 2 iatrogenic injuries (0.5%): 1 bleed and 1 perforation (0.25% each). Both were managed conservatively without complication. Conclusion: Endoscopic injuries are uncommon. Colonoscopic perforations require prompt surgical intervention. Esophagogastroduodenoscopy- and endoscopic retrograde cholangiopancreatogram–related injuries are amenable to conservative therapy in clinically stable patients devoid of peritonitis. [Copyright &y& Elsevier]

Background: Colonoscopy become a common procedure to diagnosis and treatment pathological conditions in the colon. Colonoscopic perforation is one of the most serious complications during colonoscopy thus, it may cause high morbidity and mortality. Objective: This study aims to determine incidence and risk factors of colonoscopic perforation in a training hospital. Materials and Methods: A retrospective review of medical records was performed for patients undergoing colonoscopy in Rajavithi hospital between 2009 and 2019. The patient's demographic data, indication for colonoscopy, quality of bowel preparation, endoscopic procedure, perforation, diagnostic was recorded. All statistic process was done by IBM SPSS version 20.0 Results: Between 2009 and 2019 there were 12,239 colonoscopy performed and 2,182 colonoscopy was excluded due to exclusion criteria. In total 0.71% (71/10,057) colonoscopic perforation occurred. In univariate analysis was reveal history of previous surgery, anesthesia, endoscopist, indication for colonoscopy, and endoscopic procedures were statistically significant to colonoscopic perforation. Multivariate logistic regression analysis reveal that previous gynecologic surgery (OR 41.1, p-value < 0.001, 95% C.I. 16.40-102.73), general anesthesia (OR 7.74, p-value 0.016, 95% C.I. 1.46-40.97), trainee (OR 20.74, p-value < 0.001, 95% C.I. 11.25-38.35) and polypectomy (OR 6.08, p-value < 0.001, 95% C.I. 3.15-11.70), EMR (OR 23.32, p-value <0.001, 95% C.I. 6.02-90.41) and ESD (OR 89.99, p-value < 0.001, 95% C.I. 12.74-135.46) were significant. Conclusion: Patients tend to have a higher colonoscopic perforation rate when (1) they have a history of previous gynecological surgery or (2) general anesthesia (3) the colonoscopy to be performed by a trainee or (4) polypectomy or EMR or ESD to be performed. [ABSTRACT FROM AUTHOR]

Colonic perforation is no longer a rare complication of colonoscopy. Our previous report identified 45 such iatrogenic injuries from 1980 through 1994 (3082 colonoscopies per year). This follow-up of the ensuing 7 years examines changing trends of endoscopic usage in addition to management and prognosis of patients with colonoscopic perforations. Retrospective analysis of 78,702 colonoscopies (1994 through 2000, 11,243 colonoscopies per year) allowed assessment of medical records in all patients treated at our institution for colonic perforation. Sixty-six patients from our institution (perforation rate, 0.084%; 1 per 1192 procedures) and six patients from outside institutions were treated for colonic perforation following colonoscopy (41 women, 31 men; ages, 30–92 years; median, 73 years). Sixty-two patients underwent laparotomy, while 10 were managed nonoperatively. All 10 patients managed nonoperatively were void of peritoneal irritation by physical examination; eight patients did well (median hospital stay, 5.5 days; range, 0–12), but one death (family declined operative intervention) and one pelvic abscess requiring percutaneous drainage were noted. Peritoneal irritation by physical examination was evident in 57 of 62 patients undergoing laparotomy. Perforations occurred throughout the colon: right, 22 (31%); transverse, 5 (7%); left, 44 (61%); and unknown, 1 (1%). Thirty-eight patients (61%) underwent primary repair or resection with anastomosis. Fecal diversion was used in 100% of patients with extensive peritoneal contamination (n = 12) and 40% of patients with moderate contamination (12 of 30). Perioperative morbidity (39%) and mortality (8%) were significant. Factors predicting a poor outcome included delayed diagnosis, extensive peritoneal contamination, and patients using anticoagulants (P < .05). Compared with our prior study, the present review highlights a higher prevalence of injury based on more frequent use of colonoscopy. Perforation rates remain around 0.08%. While nonoperative management is viable in patients void of peritonitis, expedient surgical intervention seems to facilitate patient recovery. [Copyright &y& Elsevier]

In a review of 5424 colonoscopies performed in the last ten years at Bronx-Lebanon Hospital Center, 14 perforations related to the procedure were found. Seven perforations occurred during therapeutic colonoscopies (polypectomies) and seven during diagnostic colonoscopies. Eight patients were treated surgically and six nonsurgically. The decision about whether or not to perform surgery for a colonoscopically induced perforation depends on the clinical condition of the patient. Nonsurgical management is indicated if the patient's general condition remains stable, if the perforation has been diagnosed late, if the pneumoperitoneum that led to the diagnosis does not increase in size, if there are no signs of peritonitis, if the patient does not have a distal obstruction, and if the patient's condition improves in response to conservative treatment. [ABSTRACT FROM AUTHOR]

Background: Perforation during colonoscopy is a rare but well recognized complication with significant morbidity and mortality. We aim to systematically review the currently available literature concerning care and outcomes of colonic perforation. An algorithm is created to guide the practitioner in management of this challenging clinical scenario., Data Sources: A systematic review of the literature based on PRISMA-P guidelines was performed. We evaluate 31 articles focusing on findings over the past 10 years., Conclusion: Colonoscopic perforation is a rare event and published management techniques are marked by their heterogeneity. Reliable conclusions are limited by the nature of the data available - mainly single institution, retrospective studies. Consensus conclusions include a higher rate of perforation from therapeutic colonoscopy when compared to diagnostic colonoscopy and the sigmoid as the most common site of perforation. Mortality appears driven by pre-existing conditions. Treatment must be tailored according to the patient's comorbidities and clinical status as well as the specific conditions during the colonoscopy that led to the perforation., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background/aims: Colonoscopic perforations have been managed with exploratory laparotomy, and have resulted in some morbidity and mortality. Recently, laparoscopic surgery is commonly performed for this purpose. The aim of this study was to compare the outcomes of several management strategies for iatrogenic colonoscopic perforations., Methods: We retrospectively reviewed the medical records of patients who had been treated for colonoscopic perforation between January 2004 and April 2013 at CHA Bundang Medical Center in Korea., Results: A total of 41 patients with colonoscopic perforation were enrolled. Twenty patients underwent conservative management with a success rate of 90%. Surgical management was performed in 23 patients including two patients who were converted to surgical management after the failure of the initial conservative management. Among 14 patients who underwent surgery at 8 hours after the perforation, there was no considerable difference in adverse outcomes between the laparotomy group and the laparoscopic surgery group. The medical costs and claim rate were 1.45 and 1.87 times greater in the exploratory laparotomy group, respectively., Conclusions: Conservative management of colonoscopic perforation could be an option for patients without overt symptoms of peritonitis or with a small defect size. If surgical management is required, laparoscopic surgery may be considered as the initial procedure even with a delayed diagnosis.

Aim: To assess the incidence and risk factors associated with colonic perforation due to colonoscopy., Methods: This was a retrospective cross-sectional study. Patients were retrospectively eligible for inclusion if they were 18 years and older and had an inpatient or outpatient colonoscopy procedure code in any facility within the Geisinger Health System during the period from January 1, 2002 to August 25, 2010. Data are presented as median and inter-quartile range, for continuous variables, and as frequency and percentage for categorical variables. Baseline comparisons across those with and without a perforation were made using the two-sample t-test and Pearson's χ² test, as appropriate., Results: A total of 50 perforations were diagnosed out of 80118 colonoscopies, which corresponded to an incidence of 0.06% (95%CI: 0.05-0.08) or a rate of 6.2 per 10000 colonoscopies. All possible risk factors associated with colonic perforation with a P-value < 0.1 were checked for inclusion in a multivariable log-binomial regression model predicting 7-d colonic perforation. The final model resulted in the following risk factors which were significantly associated with risk of colonic perforation: age, gender, body mass index, albumin level, intensive care unit (ICU) patients, inpatient setting, and abdominal pain and Crohn's disease as indications for colonoscopy., Conclusion: The cumulative 7 d incidence of colonic perforation in this cohort was 0.06%. Advanced age and female gender were significantly more likely to have perforation. Increasing albumin and BMI resulted in decreased risk of colonic perforation. Having a colonoscopy indication of abdominal pain or Crohn's disease resulted in a higher risk of colonic perforation. Colonoscopies performed in inpatients and particularly the ICU setting had substantially greater odds of perforation. Biopsy and polypectomy did not increase the risk of perforation and only three perforations occurred with screening colonoscopy.