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Iatrogenic Colonic Perforations: Changing the Paradigm.
Jose Luis Ulla-Rocha1, Angel Salgado2, Raquel Sardina3
1Digestive Diseases Unit.
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques
|January 5, 2019
Summary
Colonoscopic perforations are effectively treated with conservative management and endoscopic closure, avoiding mortality. Surgical intervention for these perforations carries a significant mortality and ostomy risk.
Area of Science:
- Gastroenterology
- Endoscopic Surgery
- Clinical Outcomes Research
Background:
- Colonoscopy is a common procedure for diagnosing and treating gastrointestinal conditions.
- Perforation is a rare but serious complication of colonoscopy.
Purpose of the Study:
- To investigate the clinical outcomes of patients who experienced colonoscopic perforations.
- To analyze factors influencing outcomes, including age, treatment method, and hospitalization length.
Main Methods:
- Retrospective study of 34 patients with colonoscopic perforations from 2009-2015.
- Analysis of patient demographics, perforation location, colonoscopy type (diagnostic/therapeutic), and treatment strategies (conservative, endoscopic closure, surgery).
Main Results:
- Most perforations occurred in the descending colon (55%) and in patients under 75 years (67.6%).
- Therapeutic colonoscopies accounted for 79.4% of perforations.
- Surgery was the most common treatment (79.4%), with a 14.8% mortality rate and 55% ostomy rate.
- Conservative or endoscopic closure methods resulted in no mortality.
Conclusions:
- Conservative management with antibiotics and parenteral nutrition, combined with endoscopic closure, is effective when diagnosis is prompt.
- While endoscopic closure shows promise, larger studies are needed to confirm these findings and optimize treatment strategies for colonoscopic perforations.
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