Recognition and Management of Colonic Perforation following Endoscopy

Thompson, Earl V.; Snyder, Jonathan R.

doi:10.1055/s-0038-1677024

Cited by 8 publications

(8 citation statements)

References 37 publications

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“…Furthermore, bowel cleansing with laxatives and enema was thoroughly completed before TRLS, and most of the intraoperative smear tests were negative. As Thompson et al 27 reported that bowel preparation before endoscopy decreases fecal contamination after perforation, the total amount of bacteria in the abdominal cavity during TRLS was expected to be small. Fecal contamination into the abdominal cavity during TRLS was possibly suppressed by the formation of the submucosal tunnel 28 .…”

Section: Discussionmentioning

confidence: 99%

Transrectal laparoscopy using flexible endoscopy with a submucosal tunneling method: Porcine survival model

Yoshida

Esaki

Satoh

et al. 2020

Digestive Endoscopy

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Objectives: Transrectal laparoscopy (TRLS) using a flexible endoscope was recently proposed for peritoneal observation. Although previous studies have reported its feasibility, followup durations were insufficient to ascertain technical safety. Moreover, knowledge about the technical feasibility of collecting peritoneal cytological lavage or ascites during TRLS is limited. Thus, this study aimed to confirm the safety and efficacy of TRLS in a porcine survival model. Methods: After creating artificial ascites in 10 animals, TRLS was performed as follows: submucosal tunnel creation on the anterior wall of the rectum, intentional perforation at the distal end of the tunnel, endoscopic ascites collection and intraperitoneal observation, and clip closure at the mucosal incision site. The pigs were administered antibiotics orally for 7 days after TRLS and killed for histological evaluation and bacterial culture after 28 days of observation. Results: The technical success rates of insertion into the abdominal cavity, ascites collection, and clip closure were 100%. All frequent anatomical sites for peritoneal dissemination including the stomach, subdiaphragmatic space, and pelvic space were fully observable without adverse events. The median procedure time was 36.3 min. Full 28-day survival was observed in all cases without any infection. The autopsies showed no infection, including abscess formation. Bacterial cultures of the peritoneal cavity were negative 28 days after TRLS in all cases. Conclusions: Transrectal laparoscopy enabled ascites collection and intraperitoneal observation without adverse events. All animals survived without peritonitis. Therefore, TRLS can be an option for intraperitoneal examination.

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Section: Discussionmentioning

confidence: 99%

Transrectal laparoscopy using flexible endoscopy with a submucosal tunneling method: Porcine survival model

Yoshida

Esaki

Satoh

et al. 2020

Digestive Endoscopy

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“…[7,8] By far, operation is recognized as the most reliable treatment for colonic perforation. [9,10] Previously, most surgeons chose open surgery (OS) for colonic perforation, but it had disadvantages such as greater trauma and slower recover. As the use of laparoscopic techniques in colorectal surgery has been widely accepted, it has become a better choice for the treatment of colonoscopic perforation.…”

Section: Introductionmentioning

confidence: 99%

“…[ 7 , 8 ] By far, operation is recognized as the most reliable treatment for colonic perforation. [ 9 , 10 ]…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic versus open surgery for colonoscopic perforation: A systematic review and meta-analysis

et al. 2023

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Background: The efficacy of laparoscopic surgery (LS) for the treatment of colonoscopic perforation is still controversial. The purpose of this meta-analysis was to evaluate the effectiveness and safety of LS versus open surgery (OS) for colonoscopic perforation.Methods: All clinical trials that compared laparoscopic with OS for colonoscopic perforation published in English were identified in PubMed, EMBASE, Web of Science, and Cochrane Library searches. A modified scale was used to assess the quality of the literature. We analyzed the age, sex ratio, aim of colonoscopy, history of abdominopelvic surgery, type of procedure, size of perforation, operation time, postoperative fasting time, hospital stay, postoperative complication morbidity, and postoperative mortality. Meta-analyses were performed using weighted mean differences for continuous variables, and odds ratios for dichotomous variables.Results: No eligible randomized trials were identified, but eleven nonrandomized trials were analyzed. In the pooled data of 192 patients who underwent LS and 131 OS, there were no significant differences in age, sex ratio, aim of colonoscopy, history of abdominopelvic surgery, perforation size, and operative time between the groups. LS group had shorter time of hospital stay and postoperative fasting time, less postoperative complication morbidity, but there were no significant difference in postoperative mortality rate between LS group and OS group.Conclusions: Based on the current meta-analysis, we conclude that LS is a safe and efficacious technique for colonoscopic perforation, with fewer postoperative complications, less hospital mortality, and faster recovery compared with OS.

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“…The incidence of perforation during diagnostic colonoscopies is 0.03–0.8% [ 4 , 5 ]. Therapeutic colonoscopies, including standard polypectomy and endoscopic mucosal resection, have a higher risk of perforation (0.07–2.1%) [ 6 ]. The timing of detection of a perforation is critical for further management and prognosis [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…Larger over-the-scope clips have been shown to effectively close larger defects, but their availability is not as widespread and expertise with their use is consequently limited. If surgery is required, minimally invasive techniques and repair rather than resection are often successful [ 6 ]. Endoscopic vacuum therapy (EVT) is an endoscopic option for the treatment of transmural gastrointestinal defects.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic Vacuum Therapy for Iatrogenic Rectal Perforation

Zumblick¹,

Stathopoulos²,

Gress³

et al. 2022

Case Rep Gastroenterol

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Serious iatrogenic bowel injuries during screening colonoscopy are rare events. If a perforation is detected during colonoscopy, endoscopic therapy can be attempted depending on the size and type as well as local endoscopic experience. We report the case of a 54-year-old female patient who was treated by endoscopic vacuum therapy (EVT) for a rectal perforation she had suffered during an outpatient screening colonoscopy. Two hours after the complication, an emergency endoscopy was performed. A perforation of the lower third of the rectum with a longitudinal diameter of 4 cm and a depth of 2.5 cm was detected. Due to the deep defect and the suspected increased risk of abscess formation after mechanical perforation closure with endoclips, we decided to perform EVT. The therapy was performed over a total period of 7 days. The patient was symptom free at all times. On the 2nd and 5th day, the endoscopic findings were re-evaluated and the inserted endosponges were changed. The sponge was adjusted to the wound conditions at each check and its length was gradually shortened. The endoscopic findings improved steadily. The EVT was completed after 7 days with the result of complete wound closure. The inflammatory parameters dropped continuously from day 1. On day 8, the patient could be discharged from inpatient treatment. No complications occurred in the post-inpatient course. This case is an example of successful EVT after iatrogenic rectal perforation. EVT should be considered for iatrogenic rectal perforation when signs of systemic inflammation are present and primary mechanical wound closure appears critical due to the depth of the defect and the presumed risk of abscess formation.

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Recognition and Management of Colonic Perforation following Endoscopy

Cited by 8 publications

References 37 publications

Transrectal laparoscopy using flexible endoscopy with a submucosal tunneling method: Porcine survival model

Transrectal laparoscopy using flexible endoscopy with a submucosal tunneling method: Porcine survival model

Laparoscopic versus open surgery for colonoscopic perforation: A systematic review and meta-analysis

Endoscopic Vacuum Therapy for Iatrogenic Rectal Perforation

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