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Surgical Endoscopy
Published in: Surgical Endoscopy 12/2019

01-12-2019 | Peritonitis | Review Article

Management of colonoscopic perforation: a systematic review and treatment algorithm

Authors: Khalid N. Alsowaina, Mooyad A. Ahmed, Nawar A. Alkhamesi, Ahmad I. Elnahas, Jeffrey D. Hawel, Nitin V. Khanna, Christopher M. Schlachta

Published in: Surgical Endoscopy | Issue 12/2019

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Abstract

Background

The aim of this review is to evaluate and summarize the current strategies used in the management of colonoscopic perforations as well as propose a modern treatment algorithm.

Methods

Articles published between January 2004 and January 2019 were screened. A total of 167 reports were identified in combined literature search, of which 61 articles were selected after exclusion of duplicate and unrelated articles. Only studies that reported on the management of endoscopic perforation in an adult population were retrieved for review. Case reports and case series of 8 patients or less were not considered. Ultimately, 19 articles were considered eligible for review.

Results

A total of 744 cases of colonoscopic perforations were reported in 19 major articles. The cause of perforation was mentioned in 16 articles. Colonoscopic perforations were reported as a consequence of diagnostic colonoscopies in 222 cases and therapeutic colonoscopies in 248 cases. The site of perforation was mentioned in 486 cases. Sigmoid colon was the predominant site followed by the cecum. The management of colonoscopic perforations was reported in a total of 741 patients. Surgical intervention was employed in 75% of the patients, of these 15% were laparoscopic and 85% required laparotomy. The predominant surgical intervention was primary repair.

Conclusion

Management strategies of colon perforations depend upon the etiology, size, severity, location, available expertise, and general health status. Usually, peritonitis, sepsis, or hemodynamic compromise requires immediate surgical management. Endoscopic techniques are under continuous evolution. Newer developments have offered high success rate with least amount of post-procedure complications. However, there is a need for further studies to compare the newer endoscopic techniques in terms of success rate, cost, complications, and the affected part of colon.
Literature
1.
Hansen AJ, Tessier DJ, Anderson ML, Schlinkert RT (2007) Laparoscopic repair of colonoscopic perforations: indications and guidelines. J Gastrointest Surg 11(5):655–659PubMed
2.
Lo AY, Beaton HL (1994) Selective management of colonoscopic perforations. J Am Coll Surg 179(3):333–337PubMed
3.
Velez MA, Riff DS, Mule JM (1997) Laparoscopic repair of a colonoscopic perforation. Surg Endosc 11(4):387–389PubMed
4.
Raju GS, Saito Y, Matsuda T, Kaltenbach T, Soetikno R (2011) Endoscopic management of colonoscopic perforations (with videos). Gastrointest Endosc 74(6):1380–1388PubMed
5.
Viiala CH, Zimmerman M, Cullen DJE, Hoffman NE (2003) Complication rates of colonoscopy in an Australian teaching hospital environment. Intern Med J 33(8):355–359PubMed
6.
Anderson ML, Pasha TM, Leighton JA (2000) Endoscopic perforation of the colon: lessons from a 10-year study. Am J Gastroenterol 95(12):3418–3422PubMed
7.
Rathgaber SW, Wick TM (2006) Colonoscopy completion and complication rates in a community gastroenterology practice. Gastrointest Endosc 64(4):556–562PubMed
8.
Regula J, Rupinski M, Kraszewska E, Polkowski M, Pachlewski J, Orlowska J et al (2006) Colonoscopy in colorectal-cancer screening for detection of advanced neoplasia. N Engl J Med 355(18):1863–1872PubMed
9.
Gatto NM, Frucht H, Sundararajan V, Jacobson JS, Grann VR, Neugut AI (2003) Risk of perforation after colonoscopy and sigmoidoscopy: a population-based study. J Natl Cancer Inst 95(3):230–236PubMed
10.
Levin TR, Zhao W, Conell C, Seeff LC, Manninen DL, Shapiro JA et al (2006) Complications of colonoscopy in an integrated health care delivery system. Ann Intern Med 145(12):880PubMed
11.
Rabeneck L, Paszat LF, Hilsden RJ, Saskin R, Leddin D, Grunfeld E et al (2008) Bleeding and perforation after outpatient colonoscopy and their risk factors in usual clinical practice. Gastroenterology 135(6):1899–1906PubMed
12.
Iqbal CW (2008) Surgical management and outcomes of 165 colonoscopic perforations from a single institution. Arch Surg 143(7):701PubMed
13.
Singh H, Penfold RB, DeCoster C, Kaita L, Proulx C, Taylor G et al (2009) Colonoscopy and its complications across a Canadian regional health authority. Gastrointest Endosc 69(3):665–671PubMed
14.
Jovanovic I, Zimmermann L, Fry LC, Mönkemüller K (2011) Feasibility of endoscopic closure of an iatrogenic colon perforation occurring during colonoscopy. Gastrointest Endosc 73(3):550–555PubMed
15.
Lohsiriwat V, Sujarittanakarn S, Akaraviputh T, Lertakyamanee N, Lohsiriwat D, Kachinthorn U (2008) Colonoscopic perforation: a report from World Gastroenterology Organization endoscopy training center in Thailand. World J Gastroenterol 14(43):6722PubMedPubMedCentral
16.
Saito Y, Fukuzawa M, Matsuda T, Fukunaga S, Sakamoto T, Uraoka T et al (2009) Clinical outcome of endoscopic submucosal dissection versus endoscopic mucosal resection of large colorectal tumors as determined by curative resection. Surg Endosc 24(2):343–352PubMed
17.
Lüning TH, Keemers-Gels ME, Barendregt WB, Tan ACITL, Rosman C (2007) Colonoscopic perforations: a review of 30,366 patients. Surg Endosc 21(6):994–997PubMed
18.
Heldwein W, Dollhopf M, Rösch T, Meining A, Schmidtsdorff G, Hasford J et al (2005) The MUNICH POLYPECTOMY STUDY (MUPS): prospective analysis of complications and risk factors in 4000 colonic snare polypectomies. Endoscopy 37(11):1116–1122PubMed
19.
Martínez-Pérez A, de’Angelis N, Brunetti F, Le Baleur Y, Payá-Llorente C, Memeo R et al (2017) Laparoscopic vs open surgery for the treatment of iatrogenic colonoscopic perforations: a systematic review and meta-analysis. World J Emerg Surg 12(1):8PubMedPubMedCentral
20.
Arora G, Mannalithara A, Singh G, Gerson LB, Triadafilopoulos G (2009) Risk of perforation from a colonoscopy in adults: a large population-based study. Gastrointest Endosc 69(3):654–664PubMed
21.
Hamdani U (2013) Risk factors for colonoscopic perforation: a population-based study of 80118 cases. World J Gastroenterol 19(23):3596PubMedPubMedCentral
22.
Chukmaitov A, Bradley CJ, Dahman B, Siangphoe U, Warren JL, Klabunde CN (2013) Association of polypectomy techniques, endoscopist volume, and facility type with colonoscopy complications. Gastrointest Endosc 77(3):436–446PubMedPubMedCentral
23.
Lorenzo-Zúñiga V, de Vega VM, Doménech E, Mañosa M, Planas R, Boix J (2010) Endoscopist experience as a risk factor for colonoscopic complications. Colorectal Dis 12(10):e273–e277PubMed
24.
Wadas DD, Sanowski RA (1988) Complications of the hot biopsy forceps technique. Gastrointest Endosc 34(1):32–37PubMed
25.
Teoh AYB (2009) Outcomes and predictors of mortality and stoma formation in surgical management of colonoscopic perforations. Arch Surg 144(1):9PubMed
26.
Yang D-H, Byeon J-S, Lee K-H, Yoon SM, Kim KJ, Ye BD et al (2009) Is endoscopic closure with clips effective for both diagnostic and therapeutic colonoscopy-associated bowel perforation? Surg Endosc 24(5):1177–1185PubMed
27.
Albuquerque W, Moreira E, Arantes V, Bittencourt P, Queiroz F (2008) Endoscopic repair of a large colonoscopic perforation with clips. Surg Endosc 22(9):2072–2074PubMed
28.
Sileri P, Blanco GDV, Benavoli D, Gaspari AL (2009) Iatrogenic rectal perforation during operative colonoscopy: closure with endoluminal clips. J Soc Laparoendosc Surg 13(1):69
29.
Quallick MR, Brown WR (2009) Rectal perforation during colonoscopic retroflexion: a large, prospective experience in an academic center. Gastrointest Endosc 69(4):960–963PubMed
30.
Thomson SR, Fraser M, Stupp C, Baker LW (1994) Iatrogenic and accidental colon injuries—what to do? Dis Colon Rectum 37(5):496–502PubMed
31.
Ignjatović M, Jović J (2008) Tension pneumothorax, pneumoretroperitoneum, and subcutaneous emphysema after colonoscopic polypectomy: a case report and review of the literature. Langenbeck’s Arch Surg 394(1):185–189
32.
Swan MP, Bourke MJ, Moss A, Williams SJ, Hopper A, Metz A (2011) The target sign: an endoscopic marker for the resection of the muscularis propria and potential perforation during colonic endoscopic mucosal resection. Gastrointest Endosc 73(1):79–85PubMed
33.
Kim DH, Pickhardt PJ, Taylor AJ, Menias CO (2008) Imaging evaluation of complications at optical colonoscopy. Curr Probl Diagn Radiol 37(4):165–177PubMed
34.
Hassan MA, Thomsen CØ, Vilmann P (2016) Endoscopic treatment of colorectal perforations—a systematic review. Danish Med J 63(4):A5220
35.
Cai SL, Chen T, Yao LQ, Zhong YS (2015) Management of iatrogenic colorectal perforation: from surgery to endoscopy. World J Gastrointest Endosc 7(8):819–823PubMedPubMedCentral
36.
Iqbal CW, Chun YS, Farley DR (2005) Colonoscopic perforations: a retrospective review. J Gastrointest Surg 9(9):1229–1236PubMed
37.
Orsoni P, Berdah S, Verrier C, Caamano A, Sastre B, Boutboul R et al (1997) Colonic perforation due to colonoscopy: a retrospective study of 48 cases. Endoscopy 29(03):160–164PubMed
38.
De Angelis N, Di Saverio S, Chiara O, Sartelli M, Martínez-Pérez A, Patrizi F et al (2018) 2017 WSES guidelines for the management of iatrogenic colonoscopy perforation. World J Emerg Surg 13:5
39.
Ryu JY, Park BK, Kim WS, Kim K, Lee JY, Kim Y et al (2019) Endoscopic closure of iatrogenic colon perforation using dual-channel endoscope with an endoloop and clips: methods and feasibility data (with videos). Surg Endosc 33(4):1342–1348PubMed
40.
Singh RR, Nussbaum JS, Kumta NA (2018) Endoscopic management of perforations, leaks and fistulas. Transl Gastroenterol Hepatol. 3:85PubMedPubMedCentral
41.
Martínez MG, Poblador AR, Raposo LG, Fernández AG, Núnez JC (2007) Perforation after colonoscopy-our 16-year experience. Rev Esp Enferm Dig 99(10):588
42.
Cobb WS, Heniford BT, Sigmon LB, Hasan R (2004) Colonoscopic perforations: incidence, management, and outcomes. Am Surg 70(9):750PubMed
43.
Samalavicius NE, Kazanavicius D, Lunevicius R, Poskus T, Valantinas J, Stanaitis J et al (2012) Incidence, risk, management, and outcomes of iatrogenic full-thickness large bowel injury associated with 56,882 colonoscopies in 14 Lithuanian hospitals. Surg Endosc 27(5):1628–1635PubMed
44.
Farley DR, Bannon MP, Zietlow SP, Pemberton JH, Ilstrup DM, Larson DR (1997) Management of colonoscopic perforations. Mayo Clin Proc 72(8):729–733PubMed
45.
Damore LJ, Rantis PC, Vernava AM, Longo WE (1996) Colonoscopic perforations. Dis Colon Rectum 39(11):1308–1314PubMed
46.
Hall C, Dorricott NJ, Donovan IA, Neoptolemos JP (1991) Colon perforation during colonoscopy: surgical versus conservative management. Br J Surg 78(5):542–544PubMed
47.
Luigiano C, Consolo P, Scaffidi M, Strangio G, Giacobbe G, Alibrandi A et al (2009) Endoscopic mucosal resection for large and giant sessile and flat colorectal polyps: a single-center experience with long-term follow-up. Endoscopy 41(10):829–835PubMed
48.
Fatima H, Rex DK (2007) Minimizing endoscopic complications: colonoscopic polypectomy. Gastrointest Endosc Clin N Am 17(1):145–156PubMed
49.
Waye JD, Kahn O, Auerbach ME (1996) Complications of colonoscopy and flexible sigmoidoscopy. Gastrointest Endosc Clin N Am 6(2):343–377PubMed
50.
Zhang Y-Q, Lu W, Yao L-Q, Qin X-Y, Xu M-D, Zhong Y-S et al (2013) Laparoscopic direct suture of perforation after diagnostic colonoscopy. Int J Colorectal Dis 28(11):1505–1509PubMed
51.
Coimbra C, Bouffioux L, Kohnen L, Deroover A, Dresse D, Denoël A et al (2010) Laparoscopic repair of colonoscopic perforation: a new standard? Surg Endosc 25(5):1514–1517PubMed
52.
Rotholtz NA, Laporte M, Lencinas S, Bun M, Canelas A, Mezzadri N (2010) Laparoscopic approach to colonic perforation due to colonoscopy. World J Surg 34(8):1949–1953PubMed
53.
Miranda L, Settembre A, Piccolboni D, Capasso P, Corcione F (2011) Iatrogenic Colonic Perforation. Surg Laparosc, Endosc Percutaneous Tech 21(3):170–174
54.
Araujo S, Seid VE, Caravatto P, Dumarco R (2009) Incidence and management of colonoscopic colon perforations: 10 years’ experience. Hepatogastroenterology 56(96):1633–1636PubMed
55.
Agresta F, Michelet I, Mainente P, Bedin N (2000) Laparoscopic management of colonoscopic perforations. Surg Endosc 14(6):592–593PubMed
56.
Nazari S, Khosroshahi SM, Khedmat H, Azhie F (2010) Repair of iatrogenic large colon perforation using laparoscopic methods. Case report and review of the literature. Middle East J Dig Dis 2(2):110–115PubMedPubMedCentral
57.
Raju GS, Pham B, Xiao S-Y, Brining D, Ahmed I (2005) A pilot study of endoscopic closure of colonic perforations with endoclips in a swine model. Gastrointest Endosc 62(5):791–795PubMed
58.
Raju GS, Ahmed I, Brining D, Xiao S-Y (2006) Endoluminal closure of large perforations of colon with clips in a porcine model (with video). Gastrointest Endosc 64(4):640–646PubMed
59.
Raju GS, Ahmed I, Xiao S-Y, Brining D, Poussard A, Tarcin O et al (2006) Controlled trial of immediate endoluminal closure of colon perforations in a porcine model by use of a novel clip device (with videos). Gastrointest Endosc 64(6):989–997PubMed
60.
Raju GS, Ahmed I, Shibukawa G, Poussard A, Brining D (2007) Endoluminal clip closure of a circular full-thickness colon resection in a porcine model (with videos). Gastrointest Endosc 65(3):503–509PubMed
61.
Raju GS, Shibukawa G, Ahmed I, Brining D, Poussard A, Xiao S-Y et al (2007) Endoluminal suturing may overcome the limitations of clip closure of a gaping wide colon perforation (with videos). Gastrointest Endosc 65(6):906–911PubMed
62.
Taku K, Sano Y, Fu K-I, Saito Y, Matsuda T, Uraoka T et al (2007) Iatrogenic perforation associated with therapeutic colonoscopy: a multicenter study in Japan. J Gastroenterol Hepatol 22(9):1409–1414PubMed
63.
Raju GS, Fritscher-Ravens A, Rothstein RI, Swain P, Gelrud A, Ahmed I et al (2008) Endoscopic closure of colon perforation compared to surgery in a porcine model: a randomized controlled trial (with videos). Gastrointest Endosc 68(2):324–332PubMed
64.
Schurr M, Hartmann C, Ho CN, Fleisch C, Kirschniak A (2008) An over-the-scope clip (OTSC) system for closure of iatrogenic colon perforations: results of an experimental survival study in pigs. Endoscopy 40(07):584–588PubMed
65.
Kang HY, Kang HW, Kim SG, Kim JS, Park K-J, Jung HC et al (2008) Incidence and management of colonoscopic perforations in Korea. Digestion 78(4):218–223PubMed
66.
Magdeburg R, Collet P, Post S, Kaehler G (2007) Endoclipping of iatrogenic colonic perforation to avoid surgery. Surg Endosc 22(6):1500–1504PubMed
67.
Trecca A, Gaj F, Gagliardi G, Fu K, Fujii T (2008) Our experience with endoscopic repair of large colonoscopic perforations and review of the literature. Tech Coloproctol 12(4):315–322PubMed
68.
Von Renteln D, Schmidt A, Vassiliou M, Rudolph H-U, Gieselmann M, Caca K (2009) Endoscopic closure of large colonic perforations using an over-the-scope clip: a randomized controlled porcine study. Endoscopy 41(06):481–486
69.
Al Ghossaini N, Lucidarme D, Bulois P (2014) Endoscopic treatment of iatrogenic gastrointestinal perforations: an overview. Digest Liver Dis 46(3):195–203
70.
Paspatis G, Dumonceau J-M, Barthet M, Meisner S, Repici A, Saunders B et al (2014) Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) position statement. Endoscopy 46(08):693–711PubMed
71.
Katsinelos P, Lazaraki G, Chatzimavroudis G, Zavos C (2014) Closure of an iatrogenic rectal perforation with the endoloop/clips technique in a purse-string fashion. Ann Gastroenterol 27:264PubMedPubMedCentral
72.
Yılmaz B, Unlu O, Roach EC, Can G, Efe C, Korkmaz U et al (2015) Endoscopic clips for the closure of acute iatrogenic perforations: where do we stand? Dig Endosc 27(6):641–648PubMed
Metadata
Title
Management of colonoscopic perforation: a systematic review and treatment algorithm
Authors
Khalid N. Alsowaina
Mooyad A. Ahmed
Nawar A. Alkhamesi
Ahmad I. Elnahas
Jeffrey D. Hawel
Nitin V. Khanna
Christopher M. Schlachta
Publication date
01-12-2019
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 12/2019
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-019-07064-7

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