Skip to main content
SpringerLink
Log in

Is endoscopic closure with clips effective for both diagnostic and therapeutic colonoscopy-associated bowel perforation?

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

An Erratum to this article was published on 17 April 2010

Abstract

Background

Colonic perforation is an uncommon but serious colonoscopy-associated complication. This study assessed the effectiveness of conservative management with endoscopic clipping for colonoscopy-associated perforations.

Methods

Clinical manifestations and management outcomes were assessed for 38 patients with colonoscopy-associated colonic perforations that occurred between January 2001 and April 2008 at the Asan Medical Center, Seoul, Korea. These perforations were classified as endoscopically evident, endoscopically suspected, and radiologically proven.

Results

Of the 38 perforations, 19 were endoscopically evident, 9 were endoscopically suspected, and 10 were radiologically proven but without endoscopic evidence. Of the 19 patients with endoscopically evident perforations, 13 (68.4%) underwent endoscopic closure with clips, and all improved without surgery. All nine patients with endoscopically suspected perforations underwent endoscopic closure, and eight (88.9%) improved without surgery. Of the 10 radiologically proven perforations, 7 were detected within 1 day after colonoscopy. All the patients improved without surgery. However, two of the three patients with delayed perforations required emergency laparotomy. Consequently, of the 38 patients with perforations, 29 (76.3%) improved without surgery. Of the 28 patients with endoscopically evident or suspected perforations, conservative management was successful for 21 (95.5%) of the 22 patients with effective clipping, but for none (0%) of the 6 patients without clipping.

Conclusions

Conservative management by immediate endoscopic closure with clips can be effective for the treatment of colonic perforations detected during colonoscopy. Conservative management also may be tried cautiously for stable patients who have radiologically proven colonoscopy-associated perforations without endoscopic evidence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Hall C, Dorricott NJ, Donovan IA, Neoptolemos JP (1991) Colon perforation during colonoscopy: surgical versus conservative management. Br J Surg 78:542–544

    Article  CAS  PubMed  Google Scholar 

  2. Carpio G, Albu E, Gumbs MA, Gerst PH (1989) Management of colonic perforation after colonoscopy: report of three cases. Dis Colon Rectum 32:624–626

    Article  CAS  PubMed  Google Scholar 

  3. Lo AY, Beaton HL (1994) Selective management of colonoscopic perforations. J Am Coll Surg 179:333–337

    CAS  PubMed  Google Scholar 

  4. Fujishiro M, Yahagi N, Kakushima N, Kodashima S, Muraki Y, Ono S, Kobayashi K, Hashimoto T, Yamamichi N, Tateishi A, Shimizu Y, Oka M, Ogura K, Kawabe T, Ichinose M, Omata M (2006) Successful nonsurgical management of perforation complicating endoscopic submucosal dissection of gastrointestinal epithelial neoplasms. Endoscopy 38:1001–1006

    Article  CAS  PubMed  Google Scholar 

  5. Magdeburg R, Collet P, Post S, Kaehler G (2008) Endoclipping of iatrogenic colonic perforation to avoid surgery. Surg Endosc 22:1500–1504

    Article  PubMed  Google Scholar 

  6. Soon JC, Shang NS, Goh PM, Rauff A (1990) Perforation of the large bowel during colonoscopy in Singapore. Am Surg 56:285–288

    CAS  PubMed  Google Scholar 

  7. Rogers BH, Silvis SE, Nebel OT, Sugawa C, Mandelstam P (1975) Complications of flexible fiberoptic colonoscopy and polypectomy. Gastrointest Endosc 22:73–77

    Article  CAS  PubMed  Google Scholar 

  8. Smith LE (1976) Fiberoptic colonoscopy: complications of colonoscopy and polypectomy. Dis Colon Rectum 19:407–412

    Article  CAS  PubMed  Google Scholar 

  9. Macrae FA, Tan KG, Williams CB (1983) Towards safer colonoscopy: a report on the complications of 5,000 diagnostic or therapeutic colonoscopies. Gut 24:376–383

    Article  CAS  PubMed  Google Scholar 

  10. Vincent M, Smith LE (1983) Management of perforation due to colonoscopy. Dis Colon Rectum 26:61–63

    Article  CAS  PubMed  Google Scholar 

  11. Nivatvongs S (1988) Complications in colonoscopic polypectomy: lessons to learn from an experience with 1,576 polyps. Am Surg 54:61–63

    CAS  PubMed  Google Scholar 

  12. Christie JP, Marrazzo J III (1991) “Mini-perforation” of the colon: not all postpolypectomy perforations require laparotomy. Dis Colon Rectum 34:132–135

    Article  CAS  PubMed  Google Scholar 

  13. Jentschura D, Raute M, Winter J, Henkel T, Kraus M, Manegold BC (1994) Complications in endoscopy of the lower gastrointestinal tract: therapy and prognosis. Surg Endosc 8:672–676

    Article  CAS  PubMed  Google Scholar 

  14. Tulchinsky H, Madhala-Givon O, Wasserberg N, Lelcuk S, Niv Y (2006) Incidence and management of colonoscopic perforations: 8 years’ experience. World J Gastroenterol 12:4211–4213

    PubMed  Google Scholar 

  15. Taku K, Sano Y, Fu KI, Saito Y, Matsuda T, Uraoka T, Yoshino T, Yamaguchi Y, Fujita M, Hattori S, Ishikawa T, Saito D, Fujii T, Kaneko E, Yoshida S (2007) Iatrogenic perforation associated with therapeutic colonoscopy: a multicenter study in Japan. J Gastroenterol Hepatol 22:1409–1414

    Article  PubMed  Google Scholar 

  16. Fujishiro M, Yahagi N, Nakamura M, Kakushima N, Kodashima S, Ono S, Kobayashi K, Hashimoto T, Yamamichi N, Tateishi A, Shimizu Y, Oka M, Ogura K, Kawabe T, Ichinose M, Omata M (2006) Endoscopic submucosal dissection for rectal epithelial neoplasia. Endoscopy 38:493–497

    Article  CAS  PubMed  Google Scholar 

  17. Tanaka S, Oka S, Kaneko I, Hirata M, Mouri R, Kanao H, Yoshida S, Chayama K (2007) Endoscopic submucosal dissection for colorectal neoplasia: possibility of standardization. Gastrointest Endosc 66:100–107

    Article  PubMed  Google Scholar 

  18. Tamegai Y, Saito Y, Masaki N, Hinohara C, Oshima T, Kogure E, Liu Y, Uemura N, Saito K (2007) Endoscopic submucosal dissection: a safe technique for colorectal tumors. Endoscopy 39:418–422

    Article  CAS  PubMed  Google Scholar 

  19. Saito Y, Uraoka T, Matsuda T, Emura F, Ikehara H, Mashimo Y, Kikuchi T, Fu KI, Sano Y, Saito D (2007) Endoscopic treatment of large superficial colorectal tumors: a case series of 200 endoscopic submucosal dissections (with video). Gastrointest Endosc 66:966–973

    Article  PubMed  Google Scholar 

  20. Hurlstone DP, Atkinson R, Sanders DS, Thomson M, Cross SS, Brown S (2007) Achieving R0 resection in the colorectum using endoscopic submucosal dissection. Br J Surg 94:1536–1542

    Article  CAS  PubMed  Google Scholar 

  21. Onozato Y, Kakizaki S, Ishihara H, Iizuka H, Sohara N, Okamura S, Mori M, Itoh H (2007) Endoscopic submucosal dissection for rectal tumors. Endoscopy 39:423–427

    Article  CAS  PubMed  Google Scholar 

  22. Iqbal CW, Chun YS, Farley DR (2005) Colonoscopic perforations: a retrospective review. J Gastrointest Surg 9:1229–1235 (discussion 1236)

    Article  PubMed  Google Scholar 

  23. Yoshikane H, Hidano H, Sakakibara A, Ayakawa T, Mori S, Kawashima H, Goto H, Niwa Y (1997) Endoscopic repair by clipping of iatrogenic colonic perforation. Gastrointest Endosc 46:464–466

    Article  CAS  PubMed  Google Scholar 

  24. Avgerinos DV, Llaguna OH, Lo AY, Leitman IM (2008) Evolving management of colonoscopic perforations. J Gastrointest Surg 12:1783–1789

    Article  PubMed  Google Scholar 

Download references

Disclosures

Dong-Hoon Yang, Jeong-Sik Byeon, Kyung-Hoon Lee, Soon Man Yoon, Kyung Jo Kim, Byong Duk Ye, Seung-Jae Myung, Suk-Kyun Yang, and Jin-Ho Kim have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, 388-1, Pungnap-2dong, Songpa-gu, Seoul, 138-736, Korea

    Dong-Hoon Yang, Jeong-Sik Byeon, Kyung-Hoon Lee, Soon Man Yoon, Kyung Jo Kim, Byong Duk Ye, Seung-Jae Myung, Suk-Kyun Yang & Jin-Ho Kim

Authors
  1. Dong-Hoon Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jeong-Sik Byeon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kyung-Hoon Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Soon Man Yoon
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kyung Jo Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Byong Duk Ye
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Seung-Jae Myung
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Suk-Kyun Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jin-Ho Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jeong-Sik Byeon.

Additional information

An erratum to this article can be found at http://dx.doi.org/10.1007/s00464-010-1062-6

Rights and permissions

Reprints and permissions

About this article

Cite this article

Yang, DH., Byeon, JS., Lee, KH. et al. Is endoscopic closure with clips effective for both diagnostic and therapeutic colonoscopy-associated bowel perforation?. Surg Endosc 24, 1177–1185 (2010). https://doi.org/10.1007/s00464-009-0746-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-009-0746-2

Keywords

Search

Navigation