Incidence and management of colonoscopic perforations: 8 years’ experience

Tulchinsky, Hagit

doi:10.3748/wjg.v12.i26.4211

Cited by 67 publications

(61 citation statements)

References 23 publications

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“…The rate of primary repair in our study was less than that of other studies, in which the rate of non-resection procedures could be 30%-60% [7,13,15,25,26] . A possible explanation for a relatively low percentage of primary repair in our series might be that half of our patients had a large perforation caused by the shaft of the scope, and many patients were suspected of having underlying colorectal cancer which required bowel resection.…”

Section: Discussioncontrasting

confidence: 80%

Colonoscopic perforation: A report from World Gastroenterology Organization endoscopy training center in Thailand

Lohsiriwat¹,

Sujarittanakarn²,

Akaraviputh³

et al. 2008

WJG

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AIM:To determine the incidence of colonoscopic perforation (CP), and evaluate clinical findings, management and outcomes of patients with CP from the World Gastroenterology Organization (WGO) Endoscopy Training Center in Thailand. METHODS: All colonoscopies and sigmoidoscopies performed between 1999 and 2007 in the Endoscopic unit, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok were reviewed. Incidence of CP, patients' characteristics, endoscopic information, intraoperative findings, management and outcomes were analyzed. RESULTS: A total of 17 357 endoscopic procedures of the colon (13 699 colonoscopies and 3658 flexible sigmoidoscopies) were performed in Siriraj hospital over a 9-year period. Fifteen patients (0.09%) had CP: 14 from colonoscopy and 1 from sigmoidoscopy. The most common site of perforation was in the sigmoid colon (80%), followed by the transverse colon (13%). Perforations were caused by direct trauma from either the shaft or the tip of the endoscope (n = 12, 80%) and endoscopic polypectomy (n = 3, 20%). All patients with CP underwent surgical management: primary repair (27%) and bowel resection (73%). The mortality rate was 13% and postoperative complication rate was 53%. CONCLUSION: CP is a rare but serious complication following colonoscopy and sigmoidoscopy, with high rates of morbidity and mortality. Incidence of CP was 0.09%. Surgery is still the mainstay of CP management.

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Section: Discussioncontrasting

confidence: 80%

Colonoscopic perforation: A report from World Gastroenterology Organization endoscopy training center in Thailand

Lohsiriwat¹,

Sujarittanakarn²,

Akaraviputh³

et al. 2008

WJG

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“…In addition, various conditions might predispose to perforation such as inflammatory bowel disease, diverticulitis, malignancy, previous abdominal surgery, strictures and adhesions. 5,6 The perforation occurred in one patient with ulcerative colitis due to direct mechanical trauma to the colon wall and the underlying cause in other patients was improper use of electocautery. the plain film may not be an accurate indicator of the defect's size and some cases of contained perforation can only be detected by tomographic studies, CT scans should be immediately considered.…”

Section: Discussionmentioning

confidence: 99%

Management of iatrogenic perforations during colonoscopy.

Birsen¹,

Ozban²,

Erbiş³

et al. 2011

Kolon Rektum Hast Derg

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ÖZET Amaç: Kolon perforasyonu, rutin ya da tedavi amaçl› yap›lan kolonoskopinin en korkulan komplikasyonlar›ndan biri haline gelmifltir. Bu komplikasyonun tedavisi takip s›ras›nda hastan›n durumuna ba¤l›d›r. Tedavi aç›k ya da laparoskopik acil cerrahi olabilece¤i gibi, konservatif de olabilir. Kolonoskopi s›ras›nda rektal retrofleksiyonun yaralanmas›n da genellikle perforasyon riski düflüktür ve yine bu hastalar›n tedavisi operasyon gerektirmeyebilir. Biz bu yaz›da, elektif kolonoskopi s›ras›nda meydana gelen kolon perforasyonu geliflen hastalar›m›z› ve tedavi yöntemlerini sunduk. Kolon Rektum Hast Derg 2011;21:57-62 geliflmifl ve perforasyon oran› %0.051 olarak izlenmifltir. Sonuç: Tedavi hastan›n klinik durumuna göre planlanmal›d›r. Hastan›n yafl›, ko-morbilitesi, perforasyonun olufl flekli, perforasyonun yeri ve büyüklü¤ü, barsak temizli¤inin yeterlili¤i, perforasyon ile tan› aras›nda geçen süre, yandafl kolorektal hastal›klar›n varl›¤›, kolonoskopi s›ras›nda geliflen perforasyon tedavisinde en önemli faktörlerdir.Anahtar Kelimeler: Kolonoskopi, Polipektomi, Perforasyon according to patients' clinical status. Patients' age and comorbidities, nature of the perforation, size and site of the perforation, the adequacy of the bowel preparation, the time between injury and diagnosis, concomitant colorectal pathologies are the most important factors in the management of perforation during colonoscopy.

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“…Las limitaciones referidas al diseño del estudio, como es obvio, reducen la amplitud de las conclusiones que podemos extraer, pero en un cálculo teórico basado en los resultados de precisión diagnóstica obtenidos en este estudio, observamos cómo se podría evitar la cuarta parte de las exploraciones endoscópicas realizadas en estos pacientes, no exentas de complicaciones (36,37). Aunque esta afirmación tiene un sustento poco firme, parece un argumento lo suficientemente atractivo como para originar un estudio con un diseño correcto para confirmar la utilidad de la ecografía en esta tarea.…”

Section: Discussionunclassified

Utilidad de la ecografía en el diagnóstico de los pacientes con sospecha de neoplasias del tubo digestivo

Ares

Aguirre

Barrenechea

et al. 2008

Rev. esp. enferm. dig.

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RESUMENIntroducción: el valor predictivo positivo de síntomas y signos en el diagnóstico del cáncer de colon y gástrico es bajo. Además, muchos pacientes son remitidos para descartar una neoplasia digestiva, sin síntomas que sugieran su localización, siendo el VPP de la clínica aún menor. En este trabajo evaluamos la utilidad de la ecografía como primera aproximación diagnóstica.Material y método: se han reclutado 79 pacientes (48 varones, edad media 69,3 años). En todos ellos se realiza una ecografía antes de la endoscopia. Se evalúa la precisión en el diagnóstico del cáncer de colon y gástrico, los diagnósticos ecográficos y el número de endoscopias que se evitarían. También se buscan factores predictivos de la localización de la neoplasia.Resultados: se han diagnosticado 5 neoplasias gástricas (6,3%) y 12 de colon (19%), 3 cáncer de páncreas (3,8%), 2 neoplasias uterinas (2,5%) y 2 hipernefromas (2,5%). Las cifras de sensibilidad, especificidad, VPP, VPN y precisión de la ecografía fueron 80%, 98,6%; 80%; 98,6%; y 97,4% respectivamente en el diagnóstico del cáncer gástrico, y del 100%, 94,5%; 80%; 100% y 95,5% respectivamente en el diagnóstico del cáncer de colon. La ecografía permitió evitar el 10% de las endoscopias. El único dato que orienta la localización de la neoplasia es la presencia de anemia, que se asocia con mayor frecuencia al diagnóstico de cáncer de colon: 30,4 versus 4,3% (p = 0,033).Conclusiones: en los pacientes remitidos para descartar una neoplasia digestiva, con síntomas inespecíficos, se diagnostica con frecuencia de patología neoplásica ajena al tubo digestivo. Si consideramos, además, la elevada precisión diagnóstica de la ecografía, esta podría ser una muy buena primera aproximación diagnóstica.Palabras clave: Cáncer de colon. Cáncer gástrico. Ecografía. Diagnóstico. Precisión. Utilidad. ABSTRACTBackground: the Positive Predictive Value (PPV) of signs and symptoms for the diagnosis of colon and gastric cancer is low. Furthermore, many patients are referred to us to discard a digestive tract neoplasm with no symptoms suggestive of its whereabouts, in whom clinical PPV is even lower. This study evaluates the usefulness of ultrasonography as a first approach to diagnosis.Material and methods: seventy-nine patients were recruited into the study (48 males with an average age of 69.3 years). Ultrasonography was performed on all patients prior to endoscopy. Parameters studied included diagnostic accuracy for colon and gastric cancer, ultrasonographic diagnoses, and number of endoscopies that can be avoided. Predictive factors for neoplasm location were also studied.Results: five gastric cancers (6.3%), 12 colon cancers (15,1%), 3 pancreatic cancers (3.8%), 2 uterine neoplasms (2.5%), and 2 hypernephromas (2.5%) were diagnosed. The figures for sensitivity, specificity, PPV, Negative Predictive Value (NPV) and global accuracy of ultrasonography were 80%, 98.6%, 80%, 98.6%, and 97.4%, respectively, for gastric cancer, while these figures were 100%, 94.5%, 80%, 100%, and 95.5%, respectively, for...

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Incidence and management of colonoscopic perforations: 8 years’ experience

Cited by 67 publications

References 23 publications

Colonoscopic perforation: A report from World Gastroenterology Organization endoscopy training center in Thailand

Colonoscopic perforation: A report from World Gastroenterology Organization endoscopy training center in Thailand

Management of iatrogenic perforations during colonoscopy.

Utilidad de la ecografía en el diagnóstico de los pacientes con sospecha de neoplasias del tubo digestivo

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