A Paradigm Shift in the Management of Acute Iatrogenic Colonic Perforations. a 24-Year Retrospective Comprehensive Study

Aims Historically, colonoscopic perforation was treated surgically in most cases. With advanced endoscopic clipping techniques (in particular, the over-the-scope-clip system) being developed during the last decade, endoscopic treatment of both diagnostic and therapeutic perforations has been effective, particularly in perforations diagnosed during the procedure. The primary objective of this study was to compare the management of acute iatrogenic perforations (AIPs) of the colon before and after the introduction of advanced clipping techniques.

Methods We conducted a retrospective study from July 1996 to February 2020. The period was divided into two sub periods, Period 1: from July 1996 to December 2012 and Period 2: from January 2013 to March 2020. All AIPs occurring during a colonoscopy and detected during or immediately (<4h) after the procedure, were included in the study.

Results The total number of colonoscopic procedures performed at our hospital was 33055 and 36831 during Period 1 & 2 respectively. 15 perforations were observed in Period 1 and 11 in Period 2. The rate of surgery was 93.3 % % (14/15) in Period 1 and 27.2 % (3/11) in Period 2(p < 0.01).The subsequent rate of endoscopic treatment increased from 6.6 % to 72.7 %. In the subgroup of cases where AIPs occurred during a diagnostic colonoscopy, the respective rate of endoscopic treatment increased from 0 % for Period 1 to 85.7 % for Period 2. The mean hospital stay in Period 1 was 6.9 days and 4 in Period 2 (p <0.01).

Conclusions Data from this historical cohort have clearly shown a decrease in the surgery rate of AIPs occurring during both diagnostic and therapeutic colonoscopy and detected during or immediately (<4h) after the procedure. A significant reduction in the length of hospitalization after the endoscopic or laparoscopic treatment of AIPs was also observed.

Citation: Fragaki M, Velegraki M, Mpitouli A etal. eP279 A PARADIGM SHIFT IN THE MANAGEMENT OF ACUTE IATROGENIC COLONIC PERFORATIONS. A 24-YEAR RETROSPECTIVE COMPREHENSIVE STUDY. Endoscopy 2021; 53: S189.

Publication History

Article published online:
19 March 2021