Management of colonoscopic perforation: a systematic review and treatment algorithm

Area of Science:

• Gastroenterology
• Surgical Procedures
• Medical Device Technology

Background:

• Colonoscopic perforations are a known complication of endoscopic procedures.
• Effective management strategies are crucial for patient outcomes.

Purpose of the Study:

• To evaluate and summarize current colonoscopic perforation management strategies.
• To propose a modern treatment algorithm for colonoscopic perforations.

Main Methods:

• A comprehensive literature search was conducted for articles published between January 2004 and January 2019.
• Nineteen eligible articles reporting on the management of endoscopic perforations in adult populations were selected for review.

Main Results:

• A total of 744 colonoscopic perforations were analyzed from 19 major articles.
• Surgical intervention was required in 75% of cases, predominantly primary repair, with laparotomy being more common than laparoscopy.
• The sigmoid colon was the most frequent site of perforation.

Conclusions:

• Management of colon perforations is tailored to etiology, size, severity, location, and patient status.
• While surgery remains prevalent, advancements in endoscopic techniques show high success rates with fewer complications.
• Further research is needed to compare newer endoscopic techniques regarding efficacy, cost, and complication rates.