Endoscopic Management of Colonoscopy‑related Perforation

ABSTRACT

Colonoscopy‑related perforation is a rare but serious complication. The type of perforation depends on whether it was caused by a diagnostic examination or as a sequelae to a therapeutic procedure. Although traditionally managed by surgery, endoscopic management is increasingly used. This review focuses on the currently available methods of endoscopic management following colonoscopy‑related perforation, together with a brief review of their efficacy. With better development of endoscopic accessories such as through‑the‑scope and over‑the‑scope clips, and increasing experience by endoscopists, it is now recommended that endoscopic management should be the preferred initial treatment modality of colonoscopy‑related perforation.

Keywords

Colonoscopy - endoscopic clipping - endoscopic suturing - iatrogenic - perforation

• References

• 1 Pourhoseingholi MA. Epidemiology and burden of colorectal cancer in Asia-pacific region: What shall we do now?. Transl Gastrointest Cancer 2014; 3: 169-73
• 2 Ng SC, Wong SH. Colorectal cancer screening in Asia. Br Med Bull 2013; 105: 29-42
• 3 Ng SC, Tang W, Ching JY, Wong M, Chow CM, Hui AJ. et al. Incidence and phenotype of inflammatory bowel disease based on results from the Asia-pacific crohn's and colitis epidemiology study. Gastroenterology 2013; 145: 158-6500
• 4 Magdeburg R, Sold M, Post S, Kaehler G. Differences in the endoscopic closure of colonic perforation due to diagnostic or therapeutic colonoscopy. Scand J Gastroenterol 2013; 48: 862-7
• 5 Shin DK, Shin SY, Park CY, Jin SM, Cho YH, Kim WH. et al. Optimal methods for the management of iatrogenic colonoscopic perforation. Clin Endosc 2016; 49: 282-8
• 6 Forsberg A, Hammar U, Ekbom A, Hultcrantz R. A register-based study: Adverse events in colonoscopies performed in Sweden 2001-2013. Scand J Gastroenterol 2017; 52: 1042-7
• 7 Zwink N, Holleczek B, Stegmaier C, Hoffmeister M, Brenner H. Complication rates in colonoscopy screening for cancer: A prospective cohort study of complications arising during the procedure and in the ensuing four weeks. Deutsch Ärztebl Int 2017; 114: 321-7
• 8 Chiba H, Tachikawa J, Kurihara D, Ashikari K, Goto T, Takahashi A. et al. Safety and efficacy of simultaneous colorectal ESD for large synchronous colorectal lesions. Endosc Int Open 2017; 5: E595-602
• 9 Odagiri H, Yasunaga H, Matsui H, Fushimi K, Iizuka T, Kaise M. et al. Hospital volume and the occurrence of bleeding and perforation after colorectal endoscopic submucosal dissection: Analysis of a national administrative database in Japan. Dis Colon Rectum 2015; 58: 597-603
• 10 Luba D, Raphael M, Zimmerman D, Luba J, Detka J, DiSario J. et al. Clipping prevents perforation in large, flat polyps. World J Gastrointest Endosc 2017; 9: 133-8
• 11 Paspatis GA, Dumonceau JM, Barthet M, Meisner S, Repici A, Saunders BP. et al. Diagnosis and management of iatrogenic endoscopic perforations: European society of gastrointestinal endoscopy (ESGE) position statement. Endoscopy 2014; 46: 693-711
• 12 Lüning TH, Keemers-Gels ME, Barendregt WB, Tan AC, Rosman C. Colonoscopic perforations: A review of 30,366 patients. Surg Endosc 2007; 21: 994-7
• 13 Saraste D, Martling A, Nilsson PJ, Blom J, Törnberg S, Hultcrantz R. et al. Complications after colonoscopy and surgery in a population-based colorectal cancer screening programme. J Med Screen 2016; 23: 135-40
• 14 Byeon JSw. Colonic perforation: Can we manage it endoscopically?. Clin Endosc 2013; 46: 495-9
• 15 Kim HH, Kye BH, Kim HJ, Cho HM. Prompt management is most important for colonic perforation after colonoscopy. Ann Coloproctol 2014; 30: 228-31
• 16 Chan WK, Roslani AC, Law CW, Goh KL, Mahadeva S. Clinical outcomes and direct costings of endoluminal clipping compared to surgery in the management of iatrogenic colonic perforation. J Dig Dis 2013; 14: 670-5
• 17 Lohsiriwat V. Colonoscopic perforation: Incidence, risk factors, management and outcome. World J Gastroenterol 2010; 16: 425-30
• 18 Alonso S, Dorcaratto D, Pera M, Seoane A, Dedeu JM, Pascual M. et al. Incidence of iatrogenic perforation during colonoscopy and their treatment in a university hospital. Cir Esp 2010; 88: 41-5
• 19 Burgess NG, Bassan MS, McLeod D, Williams SJ, Byth K, Bourke MJ. et al. Deep mural injury and perforation after colonic endoscopic mucosal resection: A new classification and analysis of risk factors. Gut 2017; 66: 1779-89
• 20 Heldwein W, Dollhopf M, Rösch T, Meining A, Schmidtsdorff G, Hasford J. et al. The Munich polypectomy study (MUPS): Prospective analysis of complications and risk factors in 4000 colonic snare polypectomies. Endoscopy 2005; 37: 1116-22
• 21 Schmidt A, Fuchs KH, Caca K, Küllmer A, Meining A. The endoscopic treatment of iatrogenic gastrointestinal perforation. Dtsch Arztebl Int 2016; 113: 121-8
• 22 Voermans RP, Le Moine O, von Renteln D, Ponchon T, Giovannini M, Bruno M. et al. Efficacy of endoscopic closure of acute perforations of the gastrointestinal tract. Clin Gastroenterol Hepatol 2012; 10: 603-8
• 23 Cho SB, Lee WS, Joo YE, Kim HR, Park SW, Park CH. et al. Therapeutic options for iatrogenic colon perforation: Feasibility of endoscopic clip closure and predictors of the need for early surgery. Surg Endosc 2012; 26: 473-9
• 24 Kim JS, Kim BW, Kim JI, Kim JH, Kim SW, Ji JS. et al. Endoscopic clip closure versus surgery for the treatment of iatrogenic colon perforations developed during diagnostic colonoscopy: A review of 115,285 patients. Surg Endosc 2013; 27: 501-4
• 25 An SB, Shin DW, Kim JY, Park SG, Lee BH, Kim JW. et al. Decision-making in the management of colonoscopic perforation: A multicentre retrospective study. Surg Endosc 2016; 30: 2914-21
• 26 Honegger C, Valli PV, Wiegand N, Bauerfeind P, Gubler C. Establishment of over-the-scope-clips (OTSC®) in daily endoscopic routine. United European Gastroenterol J 2017; 5: 247-54
• 27 Rogalski P, Daniluk J, Baniukiewicz A, Wroblewski E, Dabrowski A. Endoscopic management of gastrointestinal perforations, leaks and fistulas. World J Gastroenterol 2015; 21: 10542-52
• 28 Weiland T, Fehlker M, Gottwald T, Schurr MO. Performance of the OTSC system in the endoscopic closure of iatrogenic gastrointestinal perforations: A systematic review. Surg Endosc 2013; 27: 2258-74
• 29 van Boeckel PG, Sijbring A, Vleggaar FP, Siersema PD. Systematic review: Temporary stent placement for benign rupture or anastomotic leak of the oesophagus. Aliment Pharmacol Ther 2011; 33: 1292-301
• 30 Kim SW, Lee WH, Kim JS, Lee HN, Kim SJ, Lee SJ. et al. Successful management of colonic perforation with a covered metal stent. Korean J Intern Med 2013; 28: 715-7
• 31 Kantsevoy SV, Bitner M, Hajiyeva G, Mirovski PM, Cox ME, Swope T. et al. Endoscopic management of colonic perforations: Clips versus suturing closure (with videos). Gastrointest Endosc 2016; 84: 487-93
• 32 Bleier JI, Moon V, Feingold D, Whelan RL, Arnell T, Sonoda T. et al. Initial repair of iatrogenic colon perforation using laparoscopic methods. Surg Endosc 2008; 22: 646-9
• 33 Goelder SK, Brueckner J, Messmann H. Endoscopic hemostasis state of the art – Nonvariceal bleeding. World J Gastrointest Endosc 2016; 8: 205-11