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Surgical Endoscopy
Published in: Surgical Endoscopy 5/2013

01-05-2013

Incidence, risk, management, and outcomes of iatrogenic full-thickness large bowel injury associated with 56,882 colonoscopies in 14 Lithuanian hospitals

Authors: Narimantas Evaldas Samalavicius, Darius Kazanavicius, Raimundas Lunevicius, Tomas Poskus, Jonas Valantinas, Juozas Stanaitis, Aurelijus Grigaliunas, Audrius Gradauskas, Donatas Venskutonis, Remigijus Samuolis, Pranas Sniuolis, Mindaugas Gajauskas, Nerijus Kaselis, Raimundas Leipus, Gintautas Radziunas

Published in: Surgical Endoscopy | Issue 5/2013

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Abstract

Background

The primary goal of this hospital-based retrospective multicenter case series study was to determine the incidence of large bowel full-thickness injury associated with colonoscopy in Lithuania. We assessed characteristics of patients who were treated as a result of this complication; management and outcomes were the secondary goals of this study.

Methods

The medical records of patients with iatrogenic large bowel perforations resulting from colonoscopy within the period January 1, 2007, to December 31, 2011, were retrospectively reviewed. Representatives of 14 Lithuanian public and private hospitals participated in the survey.

Results

A total of 56,882 colonoscopies were performed. Forty patients (23 female and 17 male patients) were reported to have iatrogenic full-thickness large bowel injury. Diagnostic and therapeutic colonoscopies resulted in perforation for 28 of 49,795 patients and 12 of 7,087 patients, respectively. A mean age of 70 years and a female preponderance for this complication was revealed. Sigmoid colon and rectosigmoid junction was perforated in 28 patients. All patients underwent surgical management, either primary repair (70.0 %) or bowel resection (30.0 %). Postoperative complications were diagnosed in 15 patients. Immediate treatment resulted in fewer intestinal resections and shorter hospital stays (p < 0.05). Smoking [odds ratio (OR) 14.4, 95 % confidence interval (CI) 1.16–179.8] and a large size perforation site (15 ± 10 vs. 8 ± 5 mm; OR 1.19, 95 % CI 1.03–1.38) were risk factors for developing a postoperative complication after curative surgery. Six patients died. All deaths were related to diagnostic colonoscopy.

Conclusions

Total incidence of large bowel full-thickness injury in Lithuanian hospitals is 0.07 %. Incidence of this complication after diagnostic and therapeutic colonoscopies is 0.056 and 0.169 %, respectively. The most common site of perforation is sigmoid colon and rectosigmoid junction, at 70 %. Risk rises when colonoscopy is performed in low-volume practice centers. Urgent surgical management resulted in overall mortality rate of 15.0 % and morbidity of 37.5 %.
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Metadata
Title
Incidence, risk, management, and outcomes of iatrogenic full-thickness large bowel injury associated with 56,882 colonoscopies in 14 Lithuanian hospitals
Authors
Narimantas Evaldas Samalavicius
Darius Kazanavicius
Raimundas Lunevicius
Tomas Poskus
Jonas Valantinas
Juozas Stanaitis
Aurelijus Grigaliunas
Audrius Gradauskas
Donatas Venskutonis
Remigijus Samuolis
Pranas Sniuolis
Mindaugas Gajauskas
Nerijus Kaselis
Raimundas Leipus
Gintautas Radziunas
Publication date
01-05-2013
Publisher
Springer New York
Published in
Surgical Endoscopy / Issue 5/2013
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-012-2642-4

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