Incidence and Management of Colonoscopic Perforations in Korea

Background And Aim: Despite the low incidence of perforation after endoscopic procedures in the colon, the increasing use of these procedures is likely to cause a commensurate increase in such problems. This study was undertaken to determine the incidence of iatrogenic perforation of the colon, to define clinical characteristics, and to assess the management of these complications.

Methods: A retrospective review of the medical records was performed for all patients with iatrogenic colon perforations after endoscopy between January 2000 and June 2007.

Results: Over this 7-year study period, a total of 20,660 sigmoidoscopies, 17,102 colonoscopies, and 6,772 therapeutic procedures were performed, and 53 (0.12%) perforations were determined to be related to endoscopy. A diagnostic procedure was undertaken in 26 of these 53 perforation cases (perforation rate, 0.07%; 1 per 1,452 procedures), and a therapeutic procedure in the remaining 27 (perforation rate, 0.40%; 1 per 251 procedures). Nineteen patients (36%) were treated conservatively, and the remaining 34 (64%) required surgical management. Endoscopic clipping was performed in 9 patients, and conservative treatment was possible in 7 patients with successful closure. No procedure-related mortality occurred.

Conclusions: Endoscopic repair of iatrogenic colon perforations with clips could reduce immediate operative intervention rates.