Characteristics and endoscopic treatment of interventional and non-interventional iatrogenic colorectal perforations in centers with high endoscopic expertise: a retrospective multicenter study.
Adverse event
Colonoscopy
Complication
ESD
Endoscopic resection
Endoscopic submucosal dissection
Gastrointestinal endoscopy
Perforation
Journal
Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653
Informations de publication
Date de publication:
06 2023
06 2023
Historique:
received:
17
11
2022
accepted:
28
01
2023
medline:
5
6
2023
pubmed:
10
2
2023
entrez:
9
2
2023
Statut:
ppublish
Résumé
Iatrogenic colorectal perforation is a rare event with a relevant mortality and the need for surgical therapy in around ¾ of cases. In this retrospective multicentric cohort study iatrogenic colorectal perforations from 2004 to 2021 were analyzed. Primary outcome parameters were incidence and clinical success of 1st line endoscopic treatment. Comparative analysis of interventional and non-interventional perforations was performed and predictors for clinical success of endoscopic therapy were identified. From 103,570 colonoscopies 213 (0.2%) iatrogenic perforations were identified. 68.4% were interventional (80 during polypectomy/EMR, 54 during ESD and 11 for other reasons) and 31.6% non-interventional perforations (39 by the tip, 19 by the shaft, 7 by inversion, two by biopsy and one by distension). Incidence of 1st line endoscopic therapy was 61.0% and clinical success 81.5%. Other non-surgical therapies were conducted in 8.9% with clinical success in 94.7% of cases. In interventional perforations both incidence and clinical success of 1st line endoscopic therapy were significantly higher compared to non-interventional perforations [71.7% vs. 38.2% (p < 0.01) resp. 86.5% vs. 61.5% (p < 0.01)]. Mortality was 2.3% and significantly lower in the group of interventional perforations (0.7% vs. 5.9%, p = 0.037). Multivariable analysis revealed perforation size < 5 mm as only independent predictor for clinical success of 1st line endoscopic treatment [OR 14.85 (1.57-140.69), p = 0.019]. Endoscopic therapy is treatment of choice in the majority of iatrogenic colorectal perforations. In case of interventional perforations it is highly effective but only a minority of non-interventional perforations are good candidates for endoscopic treatment.
Sections du résumé
BACKGROUND
Iatrogenic colorectal perforation is a rare event with a relevant mortality and the need for surgical therapy in around ¾ of cases.
METHODS
In this retrospective multicentric cohort study iatrogenic colorectal perforations from 2004 to 2021 were analyzed. Primary outcome parameters were incidence and clinical success of 1st line endoscopic treatment. Comparative analysis of interventional and non-interventional perforations was performed and predictors for clinical success of endoscopic therapy were identified.
RESULTS
From 103,570 colonoscopies 213 (0.2%) iatrogenic perforations were identified. 68.4% were interventional (80 during polypectomy/EMR, 54 during ESD and 11 for other reasons) and 31.6% non-interventional perforations (39 by the tip, 19 by the shaft, 7 by inversion, two by biopsy and one by distension). Incidence of 1st line endoscopic therapy was 61.0% and clinical success 81.5%. Other non-surgical therapies were conducted in 8.9% with clinical success in 94.7% of cases. In interventional perforations both incidence and clinical success of 1st line endoscopic therapy were significantly higher compared to non-interventional perforations [71.7% vs. 38.2% (p < 0.01) resp. 86.5% vs. 61.5% (p < 0.01)]. Mortality was 2.3% and significantly lower in the group of interventional perforations (0.7% vs. 5.9%, p = 0.037). Multivariable analysis revealed perforation size < 5 mm as only independent predictor for clinical success of 1st line endoscopic treatment [OR 14.85 (1.57-140.69), p = 0.019].
CONCLUSIONS
Endoscopic therapy is treatment of choice in the majority of iatrogenic colorectal perforations. In case of interventional perforations it is highly effective but only a minority of non-interventional perforations are good candidates for endoscopic treatment.
Identifiants
pubmed: 36759355
doi: 10.1007/s00464-023-09920-z
pii: 10.1007/s00464-023-09920-z
doi:
Banques de données
DRKS
['DRKS500028012']
Types de publication
Multicenter Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
4370-4380Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Références
Paspatis GA, Arvanitakis M, Dumonceau JM et al (2020) Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) position statement—update 2020. Endoscopy 52:792–810
doi: 10.1055/a-1222-3191
pubmed: 32781470
Iqbal CW (2008) Surgical management and outcomes of 165 colonoscopic perforations from a single institution. Arch Surg 143(7):701
doi: 10.1001/archsurg.143.7.701
pubmed: 18645114
Alsowaina KN, Ahmed MA, Alkhamesi NA et al (2019) Management of colonoscopic perforation: a systematic review and treatment algorithm. Surg Endosc 33:3889–3898
doi: 10.1007/s00464-019-07064-7
pubmed: 31451923
Burgess NG, Bassan MS, McLeod D et al (2016) Deep mural injury and perforation after colonic endoscopic mucosal resection: a new classification and analysis of risk factors. Gut 0:1–11
Swan MP, Bourke MJ, Moss A et al (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):79–85
doi: 10.1016/j.gie.2010.07.003
pubmed: 21184872
Derbyshire E, Hungin P, Nickerson C, Rutter MD (2018) Colonoscopic perforations in the English National Health Service Bowel Cancer Screening Programme. Endoscopy 50(9):861–870
doi: 10.1055/a-0584-7138
pubmed: 29590669
Rabeneck L, Paszat LF, Hilsden RJ et al (2008) Bleeding and perforation after outpatient colonoscopy and their risk factors in usual clinical practice. Gastroenterology 135(6):1899–1906
doi: 10.1053/j.gastro.2008.08.058
pubmed: 18938166
Singh H, Penfold RB, DeCoster C et al (2009) Colonoscopy and its complications across a Canadian regional health authority. Gastrointest Endosc 69:665–671
doi: 10.1016/j.gie.2008.09.046
pubmed: 19251007
Arezzo A, Passera R, Marchese N et al (2016) Systematic review and meta- analysis of endoscopic submucosal dissection vs endoscopic muco- sal resection for colorectal lesions. United European Gastroenterol J 4:18–29
doi: 10.1177/2050640615585470
pubmed: 26966519
Kothari ST, Huang RJ, Shaukat A et al (2019) ASGE review of adverse events in colonoscopy. Gastrointest Endosc 90:863-876.e33
doi: 10.1016/j.gie.2019.07.033
pubmed: 31563271
Raju GS, Saito Y, Matsuda T, Kaltenbach T, Soetikno R (2011) Endoscopic management of colonoscopic perforations (with videos). Gastrointest Endosc 74(6):1380–1388
doi: 10.1016/j.gie.2011.08.007
pubmed: 22136781
Gatto NM, Frucht H, Sundararajan V et al (2003) Risk of perforation after colonoscopy and sigmoidoscopy: a population-based study. J Natl Cancer Inst 95(3):230–236
doi: 10.1093/jnci/95.3.230
pubmed: 12569145
Lohsiriwat V, Sujarittanakarn S, Akaraviputh T et al (2008) Colonoscopic perforation: a report from World Gastroenterology Organization endoscopy training center in Thailand. World J Gastroenterol 14(43):6722
doi: 10.3748/wjg.14.6722
pubmed: 19034978
pmcid: 2773317
Martinez-Perez A, de’Angelis N, Brunetti F et al (2017) Laparoscopic vs open surgery for the treatment of iatrogenic colonoscopic perforations: a systematic review and metaanalysis. World J Emerg Surg 12(1):8
doi: 10.1186/s13017-017-0121-x
pubmed: 28184237
pmcid: 5294829
Arora G, Mannalithara A, Singh G et al (2009) Risk of perforation from a colonoscopy in adults: a large population-based study. Gastrointest Endosc 69(3):654–664
doi: 10.1016/j.gie.2008.09.008
pubmed: 19251006
Hamdani U (2013) Risk factors for colonoscopic perforation: a population-based study of 80118 cases. World J Gastroenterol 19(23):3596
doi: 10.3748/wjg.v19.i23.3596
pubmed: 23801860
pmcid: 3691036
Chukmaitov A, Bradley CJ, Dahman B et al (2013) Association of polypectomy techniques, endoscopist volume, and facility type with colonoscopy complications. Gastrointest Endosc 77(3):436–446
doi: 10.1016/j.gie.2012.11.012
pubmed: 23290773
pmcid: 4857725
Lorenzo-Zuniga V, de Vega VM, Dom.nech E, et al (2010) Endoscopist experience as a risk factor for colonoscopic complications. Colorectal Dis 12(10):e273–e277
doi: 10.1111/j.1463-1318.2009.02146.x
pubmed: 19930145
Putcha RV, Burdick JS (2003) Management of iatrogenic perforation. Gastroenterol Clin North Am 32:1289–1309
doi: 10.1016/S0889-8553(03)00094-3
pubmed: 14696308
Fujiya M, Tanaka K, Dokoshi T et al (2015) Efficacy and adverse events of EMR and endoscopic submucosal dissection for the treatment of colon 48 neoplasms: a metaanalysis of studies comparing EMR and endoscopic submucosal dissection. Gastrointest Endosc 81:583–595
doi: 10.1016/j.gie.2014.07.034
pubmed: 25592748
Hong SN, Byeon JS, Lee BI et al (2016) Prediction model and risk score for perforation in patients undergoing colorectal endoscopic submu- cosal dissection. Gastrointest Endosc 84:98–108
doi: 10.1016/j.gie.2015.12.011
pubmed: 26708921
Bielawska B, Day AG, Lieberman DA et al (2014) Risk factors for early colonoscopic perforation include non-gastroenterologist endoscopists: a multivariable analysis. Clin Gastroenterol Hepatol 12:85–92
doi: 10.1016/j.cgh.2013.06.030
pubmed: 23891916
Campos S, Amaro P, Portela F, Sofia C (2016) Iatrogenic Perforations During Colonoscopy in a Portuguese Population: A Study Including In and Out-Of-Hospital Procedures. GE Port J Gastroenterol 23(4):183–189
doi: 10.1016/j.jpge.2016.02.007
pubmed: 28868458
pmcid: 5580015
Al Ghossaini N, Lucidarme D, Bulois P (2014) Endoscopic treatment of iatrogenic gastrointestinal perforations: an overview. Digest Liver Dis 46(3):195–203
doi: 10.1016/j.dld.2013.09.024
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 27:264
pubmed: 24975426
pmcid: 4073026
Ryu JY, Park BK, Kim WS et al (2019) Endoscopic closure of iatrogenic colon perforation using dualchannel endoscope with an endoloop and clips: methods and feasibility data (with videos). Surg Endosc 33(4):1342–1348
doi: 10.1007/s00464-018-06616-7
pubmed: 30604267
Singhal S, Changela K, Papafragkakis H et al (2013) Over the scope clip: technique and expanding clinical applications. J Clin Gastroenterol 47:749–756
doi: 10.1097/MCG.0b013e318296ecb9
pubmed: 23751852
Weiland T, Fehlker M, Gottwald T et al (2013) Performance of the OTSC system in the endoscopic closure of iatrogenic gastrointestinal perforations: a systematic review. Surg Endosc 27:2258–2274
doi: 10.1007/s00464-012-2754-x
pubmed: 23340813
Voermans RP, Le Moine O, von Renteln D et al (2012) Efficacy of endoscopic closure of acute perforations of the gastrointestinal tract. Clin Gastroenterol Hepatol 10:603–608
doi: 10.1016/j.cgh.2012.02.005
pubmed: 22361277
Kühn F, Schardey J, Wirth U et al (2022) Endoscopic vacuum therapy for the treatment of colorectal leaks—a systematic review and meta-analysis. Int J Colorectal Dis 37:283–292
doi: 10.1007/s00384-021-04066-7
pubmed: 34817647
Han JH, Park S, Youn S (2011) Endoscopic closure of colon perforation with band ligation; salvage technique after endoclip failure. Clin Gastro- enterol Hepatol 9:e54–e55
doi: 10.1016/j.cgh.2010.12.026
Kantsevoy SV, Bitner M, Hajiyeva G et al (2016) Endoscopic management of colonic perforations: clips versus suturing closure (with videos). Gastrointest Endosc 84:487–493
doi: 10.1016/j.gie.2015.08.074
pubmed: 26364965
Yılmaz B, Unlu O, Roach EC et al (2015) Endoscopic clips for the closure of acute iatrogenic perforations: where do we stand? Dig Endosc 27(6):641–648
doi: 10.1111/den.12482
pubmed: 25919698
Anderson ML, Pasha TM, Leighton JA (2000) Endoscopic perforation of the colon: lessons from a 10-year study. Am J Gastroenterol 95(12):3418–22
doi: 10.1111/j.1572-0241.2000.03356.x
pubmed: 11151871
Wadas DD, Sanowski RA (1988) Complications of the hot biopsy forceps technique. Gastrointest Endosc 34(1):32–37
doi: 10.1016/S0016-5107(88)71226-2
pubmed: 3258260
Heldwein W, Dollhopf M, Rosch T et al (2005) The Munich Polypectomy Study (MUPS): prospective analysis of complications and risk factors in 4000 colonic snare polypectomies. Endoscopy 37:1116–1122
doi: 10.1055/s-2005-870512
pubmed: 16281142
Yang DH, Byeon JS, Lee KH et al (2009) Is endoscopic closure with clips effective for both diagnostic and therapeutic colonoscopy-associated bowel perforation? Surg Endosc 24(5):1177–1185
doi: 10.1007/s00464-009-0746-2
pubmed: 19915907
Magdeburg R, Sold M, Post S et al (2013) Differences in the endoscopic closure of colonic perforation due to diagnostic or therapeutic colonoscopy. Scand J Gastroenterol 48:862–867
doi: 10.3109/00365521.2013.793737
pubmed: 23697700
Jovanovic I, Zimmermann L, Fry LC et al (2011) Feasibility of endoscopic closure of an iatrogenic colon perforation occurring during colonoscopy. Gastrointest Endosc 73:550–555
doi: 10.1016/j.gie.2010.12.026
pubmed: 21353851