Complications of diagnostic and therapeutic colonoscopy within a defined population in Sweden

Dafnis, George; Ekbom, Anders; Påhlman, Lars; Blomqvist, Peter

doi:10.1067/mge.2001.117545

Cited by 166 publications

(100 citation statements)

References 31 publications

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“…This study found the perforation risk for colonoscopic procedures to be four times higher, exceeding the relative risk ratio of 2 described in previous reports [8]. Several studies have shown a difference in perforation rates between diagnostic and therapeutic procedures [4,9].…”

Section: Discussionmentioning

confidence: 48%

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Colonoscopic perforations: a review of 30,366 patients

et al. 2007

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Background: Although the incidence of perforation after endoscopic procedures of the colon is low, the rising number of procedures could pose relevant health problems. Recognizing risk factors and optimizing treatment may reduce perforation incidence and the probability of (severe) complications. This study aimed to determine perforation frequency and the management of endoscopic colonoscopic perforation. Methods: A retrospective review of patient records was performed for all patients with iatrogenic colonic perforations after sigmoido/colonoscopy between 1990 and 2005. The patientsÕ demographic data, endoscopic procedural information, perforation location, therapy, and outcome were recorded. Results: In the 16-year period, 30,366 endoscopic colonic procedures were performed. In total, 35 colonic perforations occured (0.12%). All the patients underwent a laparotomy: for primary repair in 18 cases (56%), for resection with anastomosis in 8 cases (25%), and for resection without anastomosis in 6 cases (19%). In three patients (8.6%), no perforation was found. The postoperative course was uncomplicated in 21 cases (60%) and complicated in 14 cases (40%), including mortality for 3 patients (8.6% resulting from perforations and 0.01% resulting from total endoscopic colon procedures). The relative risk ratio of colonoscopic and sigmoidoscopic procedures for perforations was 4. Therapeutic procedures show a delay in presentation and diagnosis compared with diagnostic procedures. Of the 35 perforations, 26 (74%) occurred in the sigmoid colon. Conclusion: Iatrogenic colonic perforation is a serious but rare complication of colonoscopy. A perforation risk of 0.12% was found. The perforation risk was higher for colonoscopic procedures than for sigmoidoscopic procedures. The sigmoid colon is the area at greatest risk for perforation. Immediate operative management, preferably primary repair and sometimes resection, appears to be a good strategy for most patients. Key words: Colon perforation -ColonoscopyComplication -Endoscopy -IatrogenicColonic perforation resulting from colonoscopic and sigmoidoscopic procedures is a rare but serious complication with high rates of morbidity and mortality [1,3,6,7,12]. The frequency of perforations after colonoscopy is estimated to be 0.03% to 0.8% for diagnostic colonoscopy and 0.15% to 3% for therapeutic colonoscopy [22]. With increasing numbers of colonoscopies being performed for screening purposes, this small possibility of perforations still may cause a high number of clinical problems. The optimal treatment for perforations, whether conservative or operative, still is unclear because no randomized trial has ever been conducted.Recent studies are acquiring evidence for laparoscopic and endoluminal repair using clips for perforation closure [15-17, 19, 22]. Knowing risk factors, recognizing early signs of perforation, and giving early and optimal treatment may reduce the probability of (severe) complications and death from iatrogenic colon perforations. In this report, we re...

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Section: Discussionmentioning

confidence: 48%

“…Perforations after therapeutic procedures often are diagnosed late, probably because of different pathophysiologic mechanisms [2,4]. In diagnostic procedures, perforations most often result from pressure to the colonic wall and can be noticed immediately via visualization of extra-intestinal tissue by the endoscopist.…”

Section: Discussionmentioning

confidence: 99%

Colonoscopic perforations: a review of 30,366 patients

et al. 2007

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“…Perforation rates decrease with the experience of the endoscopist (3,12). However, experience alone is not sufficient to prevent perforations due to the various risk factors discussed previously.…”

Section: Discussionmentioning

confidence: 99%

Colonoscopic perforations: Single center experience and review of the literature

Çolak¹,

Gürbulak²,

Bektaş³

et al. 2017

Turk J Surg

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Colonoscopic perforations: Single center experience and review of the literature INTRODUCTION Colonoscopy is accepted as the gold standard imaging modality for the diagnosis of colon and distal ileum diseases. It aids the detection of smaller lesions and tissue sampling and also functions as a therapeutic procedure for intestinal diseases. Similar to other invasive procedures, colonoscopy has been associated with various complications; among these, perforation is the most important. Iatrogenic colonic perforation has high rates of mortality and morbidity. It is mainly divided into two categories: diagnostic and therapeutic (1, 2). Management includes both medical and surgical approaches. However, the best approach for treatment depends on various factors, such as the patient's general condition, age, comorbidities, and, most importantly, the time between the onset and diagnosis of perforation. In this study, we aimed to evaluate the incidence of perforation in a large colonoscopy series, discuss patient management strategies, and analyze the clinical consequences of iatrogenic colonic perforation. MATERIAL AND METHODSBetween January 2005 and May 2015, a total of 31,655 lower GIS endoscopies were performed at our center. Patients with iatrogenic colonic perforations were investigated retrospectively. All procedures were conducted under sedoanalgesia. The procedures were performed by 27 endoscopists, including 24 general surgeons and 3 gastroenterology specialists. The experience of the endoscopists varied between 2 and 15 years.We analyzed the demographic characteristics of the patients, the type of procedure (therapeutic or diagnostic), indications for colonoscopy and associated colonic disease, location and detection time of perforation, management strategy (operative or nonoperative), and complications.The perforations were detected either during colonoscopy by observing a visible defect in the colonic wall (mesenteric or antimesenteric side) or after the procedure by detecting free intra-abdominal air upon radiological examination. Patients who complained of abdominal pain or distention following 195Objective: Iatrogenic colonic perforation is a well-known complication that can increase mortality and morbidity in patients undergoing colonoscopy. Closer follow-up and a well-planned treatment strategy are required when perforation arises as a complication. The aims of this study are to (1) report our experience with a large colonoscopy series; (2) evaluate the underlying mechanisms of iatrogenic colonic perforation; (3) discuss the ideal period between onset and treatment; and (4) review the current literature regarding the management of iatrogenic colonic perforations. Material and Methods:Patients who underwent colonoscopy between January 2005 and May 2015 at a single center were reviewed retrospectively. Procedures during which colonic perforations occurred were documented and analyzed.Results: Between January 2005 and May 2015, 31,655 patients underwent colonoscopy and 5,214 patients underwent recto-sigmoi...

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“…As principais complicações em polipectomia com alça diatérmica são sangramento, perfuração e dor abdominal 14,15 e estão associadas ao tamanho do pólipo 7,16,17,18,19,20 e são aqui demonstradas nas Tabelas 1, 2, 3 e 4. O tratamento destas complicações, em colonoscopia terapêutica, costuma ser por via endoscópica para hemorragia e conservador, não cirúrgico, para perfuração [21][22] .…”

Section: Discussionunclassified

Colonoscopia com polipectomia: análise crítica de fatores de risco e complicações

Silva

Pelosi²,

Freitas³

et al. 2009

Rev bras. colo-proctol.

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Tratalho realizado no Serviço de Coloproctologia do HSE-RJ e no Serviço de Endoscopia Digestiva da Casa de Portugal -RJ. Recebido em 19/03/2009 Aceito para publicação em 28/04/2009 INTRODUÇÃOAdenoma é precursor do câncer colorretal 1-2 e a sua remoção serve como prevenção 3,4,5,6 . A intenção deste estudo é de avaliar os efeitos adversos da polipectomia realizada com alça diatérmica. PACIENTES E MÉTODOSAnalisamos de forma retrospectiva 1687 polipectomias com alça diatérmica realizadas em 8447 colonoscopias em duas instituições médicas no período de 2001 a 2007. Duzentos e três pólipos eram maiores do que 2 cm de diâmetro. Teste t de Student foi utilizado para análise de média e desvio padrão e qui-quadrado para números absolutos. P < que 0,05 foi considerado significante. As grandes lesões sésseis foram abordadas por técnica combinada, isto é, polipectomia convencional com alça diatérmica complementada por mucosectomia para retirada completa e segura das margens. Não abordamos neste estudo ressecções de lesões planas ou plana-elevadas por mucosectomia. RESULTADOSEm 1687 polipectomias, 203 foram para pólipos maiores do que 2 cm, considerados grandes, sendo que o maior deles tinha10 cm de diâmetro.A tabela 1 mostra a incidência de sangramento imediato quando comparamos o tamanho dos pólipos.Sangramento tardio, aquele que ocorreu após 24 h do procedimento pode ser visto na tabela 2.

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Complications of diagnostic and therapeutic colonoscopy within a defined population in Sweden

Cited by 166 publications

References 31 publications

Colonoscopic perforations: a review of 30,366 patients

Colonoscopic perforations: a review of 30,366 patients

Colonoscopic perforations: Single center experience and review of the literature

Colonoscopia com polipectomia: análise crítica de fatores de risco e complicações

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