Successful Endoscopic Repair of an Iatrogenic Colonic Perforation During Diagnostic Colonoscopy

Abstract

Colonoscopy is the best method for the diagnosis, treatment, and follow-up of colorectal cancer. Although it is generally considered a safe procedure, complications during colonoscopy may occur. The most serious complication is iatrogenic perforation of the colon. Although rare, it can be potentially lethal, especially when it is not recognized and treated immediately. The traditional management of iatrogenic colonic perforation is surgical repair, either by laparotomy or laparoscopy. However, with the recent improvement of endoscopic devices and techniques, endoscopic repair of iatrogenic colonic perforation using endoclips is considered to be both feasible and effective. We successfully used endoscopic clipping to treat a patient with a large perforation of the colon during diagnostic colonoscopy. We believe that the endoscopic repair avoids unnecessary surgery and reduces medical costs. (J Am Board Fam Med 2012;25:383-389.)

Management of complications following endoscopic submucosal dissection for gastric cancer

“…Although clipping is the most common treatment for perforation, a hemoclip can obscure visibility of structur-es such as the gastroesophageal junction and the posterior wall of the upper gastric body. Band ligation may thus be a preferable treatment option [18] . Additionally, a clip may not encompass a wide perforation; in such cases, suction of the omentum can be applied to aid the clipping of the perforated area.…”

The Major Complications of Colonoscopy: Sedation-Related, Hemorrhage Associated with Polypectomy and Colonic Perforation

“…It has been reported that nonsurgical management may be appropriate for some individuals [60,61] but these patients should still undergo surgical consultation and close monitoring for signs of deterioration. Successful endoscopic repair of an iatrogenic colonic perforation occurring during diagnostic colonoscopy has been reported [62] and the efficacy of a new Over-the Scope-Clip (OTSC-Ovesco Endoscopy AG, Tübingen, Germany) device (a bear trap-like, large clip with a wingspan of 12 mms. that grasps much more tissue than the small endoscopic clips used previously and can create a full-thickness closure of perforations up to 3 cms.…”

Comparison of endoscopic band ligation and endoclip closure of colonic perforation: Technical feasibility and efficacy in an ex vivo pig model

“…Although several devices have been developed to overcome the limitations of endoclipping, most of the devices are not in wide use because of their prototype status or high cost . However, several cases have been reported wherein endoscopic closure of iatrogenic colon perforations by endoscopic band ligation (EBL) is successful even though earlier treatment with endoclipping failed . Moreover, EBL is already being widely used for controlling both variceal and non‐variceal bleeding .…”

“…[18][19][20][21][22][23] However, several cases have been reported wherein endoscopic closure of iatrogenic colon perforations by endoscopic band ligation (EBL) is successful even though earlier treatment with endoclipping failed. 17,[24][25][26][27][28] Moreover, EBL is already being widely used for controlling both variceal and non-variceal bleeding. [29][30][31][32] To our knowledge, the role of EBL in colonic perforation has not been investigated prospectively either ex vivo or in vivo.…”