Incidence of colonoscopy-related perforation and risk factors for poor outcomes: 3-year results from a prospective, multicenter registry (with videos).
Colonoscopy
Incidence
Perforation
Risk factor
Journal
Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653
Informations de publication
Date de publication:
08 2023
08 2023
Historique:
received:
19
05
2022
accepted:
26
03
2023
medline:
14
7
2023
pubmed:
18
4
2023
entrez:
17
4
2023
Statut:
ppublish
Résumé
Perforation is a life-threatening adverse event of colonoscopy that often requires hospitalization and surgery. We aimed to prospectively assess the incidence of colonoscopy-related perforation in a multicenter registry and to analyze the clinical factors associated with poor clinical outcomes. This prospective observational study was conducted at six tertiary referral hospitals between 2017 and 2020, and included patients with colonic perforation after colonoscopy. Poor clinical outcomes were defined as mortality, surgery, and prolonged hospitalization (> 13 days). Logistic regression was used to identify factors associated with poor clinical outcomes. Among 84,673 patients undergoing colonoscopy, 56 had colon perforation (0.66/1000, 95% confidence interval [CI] 0.51-0.86). Perforation occurred in 12 of 63,602 diagnostic colonoscopies (0.19/1000, 95% CI 0.11-0.33) and 44 of 21,071 therapeutic colonoscopies (2.09/1000, 95% CI 1.55-2.81). Of these, 15 (26.8%) patients underwent surgery, and 25 (44.6%) patients had a prolonged hospital stay. One patient (1.8%) died after perforation from a diagnostic colonoscopy. In the multivariate analysis, diagnostic colonoscopy (adjusted odds ratio [aOR] 196.43, p = 0.025) and abdominal rebound tenderness (aOR 17.82, p = 0.012) were independent risk factors for surgical treatment. The location of the sigmoid colon (aOR 18.57, p = 0.048), delayed recognition (aOR 187.71, p = 0.008), and abdominal tenderness (aOR 63.20, p = 0.017) were independent risk factors for prolonged hospitalization. This prospective study demonstrated that the incidence of colonoscopy-related perforation was 0.66/1000. The incidence rate was higher in therapeutic colonoscopy, whereas the risk for undergoing surgery was higher in patients undergoing diagnostic colonoscopy. Colonoscopy indication (diagnostic vs. therapeutic), physical signs, the location of the sigmoid perforation, and delayed recognition were independent risk factors for poor clinical outcomes in colonoscopy-related perforation.
Sections du résumé
BACKGROUND AND AIMS
Perforation is a life-threatening adverse event of colonoscopy that often requires hospitalization and surgery. We aimed to prospectively assess the incidence of colonoscopy-related perforation in a multicenter registry and to analyze the clinical factors associated with poor clinical outcomes.
METHODS
This prospective observational study was conducted at six tertiary referral hospitals between 2017 and 2020, and included patients with colonic perforation after colonoscopy. Poor clinical outcomes were defined as mortality, surgery, and prolonged hospitalization (> 13 days). Logistic regression was used to identify factors associated with poor clinical outcomes.
RESULTS
Among 84,673 patients undergoing colonoscopy, 56 had colon perforation (0.66/1000, 95% confidence interval [CI] 0.51-0.86). Perforation occurred in 12 of 63,602 diagnostic colonoscopies (0.19/1000, 95% CI 0.11-0.33) and 44 of 21,071 therapeutic colonoscopies (2.09/1000, 95% CI 1.55-2.81). Of these, 15 (26.8%) patients underwent surgery, and 25 (44.6%) patients had a prolonged hospital stay. One patient (1.8%) died after perforation from a diagnostic colonoscopy. In the multivariate analysis, diagnostic colonoscopy (adjusted odds ratio [aOR] 196.43, p = 0.025) and abdominal rebound tenderness (aOR 17.82, p = 0.012) were independent risk factors for surgical treatment. The location of the sigmoid colon (aOR 18.57, p = 0.048), delayed recognition (aOR 187.71, p = 0.008), and abdominal tenderness (aOR 63.20, p = 0.017) were independent risk factors for prolonged hospitalization.
CONCLUSIONS
This prospective study demonstrated that the incidence of colonoscopy-related perforation was 0.66/1000. The incidence rate was higher in therapeutic colonoscopy, whereas the risk for undergoing surgery was higher in patients undergoing diagnostic colonoscopy. Colonoscopy indication (diagnostic vs. therapeutic), physical signs, the location of the sigmoid perforation, and delayed recognition were independent risk factors for poor clinical outcomes in colonoscopy-related perforation.
Identifiants
pubmed: 37069430
doi: 10.1007/s00464-023-10046-5
pii: 10.1007/s00464-023-10046-5
doi:
Types de publication
Observational Study
Multicenter Study
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
5865-5874Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Références
Lohsiriwat V (2010) Colonoscopic perforation: incidence, risk factors, management and outcome. World J Gastroenterol 16:425–430
doi: 10.3748/wjg.v16.i4.425
pubmed: 20101766
pmcid: 2811793
Oh HM, Cha JM, Shin S, Park J, Cho D, Choi S (2021) Medico-legal implications for the colon perforation during colonoscopy. J Forensic Leg Med 80:102185
doi: 10.1016/j.jflm.2021.102185
pubmed: 34000660
Stock C, Ihle P, Sieg A, Schubert I, Hoffmeister M, Brenner H (2013) Adverse events requiring hospitalization within 30 days after outpatient screening and nonscreening colonoscopies. Gastrointest Endosc 77:419–429
doi: 10.1016/j.gie.2012.10.028
pubmed: 23410698
Luning TH, Keemers-Gels ME, Barendregt WB, Tan AC, Rosman C (2007) Colonoscopic perforations: a review of 30,366 patients. Surg Endosc 21:994–997
doi: 10.1007/s00464-007-9251-7
pubmed: 17453289
Cai SL, Chen T, Yao LQ, Zhong YS (2015) Management of iatrogenic colorectal perforation: From surgery to endoscopy. World J Gastrointest Endosc 7:819–823
doi: 10.4253/wjge.v7.i8.819
pubmed: 26191347
pmcid: 4501973
Sieg A, Hachmoeller-Eisenbach U, Eisenbach T (2001) Prospective evaluation of complications in outpatient GI endoscopy: a survey among German gastroenterologists. Gastrointest Endosc 53:620–627
doi: 10.1067/mge.2001.114422
pubmed: 11323588
Iqbal CW, Cullinane DC, Schiller HJ, Sawyer MD, Zietlow SP, Farley DR (2008) Surgical management and outcomes of 165 colonoscopic perforations from a single institution. Arch Surg 143:701–706 (discussion 706-707)
doi: 10.1001/archsurg.143.7.701
pubmed: 18645114
van der Sluis FJ, Loffeld RJ, Engel AF (2012) Outcome of surgery for colonoscopic perforation. Colorectal Dis 14:e187-190
doi: 10.1111/j.1463-1318.2011.02841.x
pubmed: 21955545
Garcia Martinez MT, Ruano Poblador A, Galan Raposo L, Gay Fernandez AM, Casal Nunez JE (2007) Perforation after colonoscopy: our 16-year experience. Rev Esp Enferm Dig 99:588–592
pubmed: 18052662
Sivaram P, Sreekumar A (2018) Preoperative factors influencing mortality and morbidity in peptic ulcer perforation. Eur J Trauma Emerg Surg 44:251–257
doi: 10.1007/s00068-017-0777-7
pubmed: 28258286
Hamdani U, Naeem R, Haider F, Bansal P, Komar M, Diehl DL, Kirchner HL (2013) Risk factors for colonoscopic perforation: a population-based study of 80118 cases. World J Gastroenterol 19:3596–3601
doi: 10.3748/wjg.v19.i23.3596
pubmed: 23801860
pmcid: 3691036
Moss A, Nalankilli K (2017) Standardisation of polypectomy technique. Best Pract Res Clin Gastroenterol 31:447–453
doi: 10.1016/j.bpg.2017.05.007
pubmed: 28842055
Yamamoto H, Yahagi N, Oyama T (2005) Mucosectomy in the colon with endoscopic submucosal dissection. Endoscopy 37:764–768
doi: 10.1055/s-2005-870166
pubmed: 16032498
Choi YS, Kim WS, Hwang SW, Park SH, Yang DH, Ye BD, Myung SJ, Yang SK, Byeon JS (2020) Clinical outcomes of submucosal colorectal cancer diagnosed after endoscopic resection: a focus on the need for surgery. Intest Res 18:96–106
doi: 10.5217/ir.2019.00092
pubmed: 32013317
pmcid: 7000636
Catto AJ, Grant PJ (1995) Risk factors for cerebrovascular disease and the role of coagulation and fibrinolysis. Blood Coagul Fibrinolysis 6:497–510
doi: 10.1097/00001721-199509000-00001
pubmed: 7578890
Sharma A, Nagalli S (2021) Chronic liver disease. StatPearls, Treasure Island (FL)
Thomas H, Diamond J, Vieco A, Chaudhuri S, Shinnar E, Cromer S, Perel P, Mensah GA, Narula J, Johnson CO, Roth GA, Moran AE (2018) Global atlas of cardiovascular disease 2000–2016: the path to prevention and control. Glob Heart 13:143–163
doi: 10.1016/j.gheart.2018.09.511
pubmed: 30301680
Levey AS, Eckardt KU, Tsukamoto Y, Levin A, Coresh J, Rossert J, De Zeeuw D, Hostetter TH, Lameire N, Eknoyan G (2005) Definition and classification of chronic kidney disease: a position statement from Kidney Disease: improving Global Outcomes (KDIGO). Kidney Int 67:2089–2100
doi: 10.1111/j.1523-1755.2005.00365.x
pubmed: 15882252
Samalavicius NE, Kazanavicius D, Lunevicius R, Poskus T, Valantinas J, Stanaitis J, Grigaliunas A, Gradauskas A, Venskutonis D, Samuolis R, Sniuolis P, Gajauskas M, Kaselis N, Leipus R, Radziunas G (2013) Incidence, risk, management, and outcomes of iatrogenic full-thickness large bowel injury associated with 56,882 colonoscopies in 14 Lithuanian hospitals. Surg Endosc 27:1628–1635
doi: 10.1007/s00464-012-2642-4
pubmed: 23233015
Arora G, Mannalithara A, Singh G, Gerson LB, Triadafilopoulos G (2009) Risk of perforation from a colonoscopy in adults: a large population-based study. Gastrointest Endosc 69:654–664
doi: 10.1016/j.gie.2008.09.008
pubmed: 19251006
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
doi: 10.3748/wjg.v12.i26.4211
pubmed: 16830377
pmcid: 4087376
Reumkens A, Rondagh EJ, Bakker CM, Winkens B, Masclee AA, Sanduleanu S (2016) Post-colonoscopy complications: a systematic review, time trends, and meta-analysis of population-based studies. Am J Gastroenterol 111:1092–1101
doi: 10.1038/ajg.2016.234
pubmed: 27296945
de’Angelis N, Di Saverio S, Chiara O, Sartelli M, Martinez-Perez A, Patrizi F, Weber DG, Ansaloni L, Biffl W, Ben-Ishay O, Bala M, Brunetti F, Gaiani F, Abdalla S, Amiot A, Bahouth H, Bianchi G, Casanova D, Coccolini F, Coimbra R, de’Angelis GL, De Simone B, Fraga GP, Genova P, Ivatury R, Kashuk JL, Kirkpatrick AW, Le Baleur Y, Machado F, Machain GM, Maier RV, Chichom-Mefire A, Memeo R, Mesquita C, Salamea Molina JC, Mutignani M, Manzano-Nunez R, Ordonez C, Peitzman AB, Pereira BM, Picetti E, Pisano M, Puyana JC, Rizoli S, Siddiqui M, Sobhani I, Ten Broek RP, Zorcolo L, Carra MC, Kluger Y, Catena F (2018) 2017 WSES guidelines for the management of iatrogenic colonoscopy perforation. World J Emerg Surg 13:5
doi: 10.1186/s13017-018-0162-9
pubmed: 29416554
pmcid: 5784542
Rex DK, Schoenfeld PS, Cohen J, Pike IM, Adler DG, Fennerty MB, Lieb JG 2nd, Park WG, Rizk MK, Sawhney MS, Shaheen NJ, Wani S, Weinberg DS (2015) Quality indicators for colonoscopy. Am J Gastroenterol 110:72–90
doi: 10.1038/ajg.2014.385
pubmed: 25448873
Rembacken B, Hassan C, Riemann JF, Chilton A, Rutter M, Dumonceau JM, Omar M, Ponchon T (2012) Quality in screening colonoscopy: position statement of the European Society of Gastrointestinal Endoscopy (ESGE). Endoscopy 44:957–968
doi: 10.1055/s-0032-1325686
pubmed: 22987217
Magdeburg R, Sold M, Post S, Kaehler G (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
Panteris V, Haringsma J, Kuipers EJ (2009) Colonoscopy perforation rate, mechanisms and outcome: from diagnostic to therapeutic colonoscopy. Endoscopy 41:941–951
doi: 10.1055/s-0029-1215179
pubmed: 19866393
Macaluso CR, McNamara RM (2012) Evaluation and management of acute abdominal pain in the emergency department. Int J Gen Med 5:789–797
doi: 10.2147/IJGM.S25936
pubmed: 23055768
pmcid: 3468117
Hopkins A (1966) Relation between pressure and volume in hollow viscera. Gut 7:521–524
doi: 10.1136/gut.7.5.521
pubmed: 5929265
pmcid: 1552478
Manabe N, Haruma K, Nakajima A, Yamada M, Maruyama Y, Gushimiyagi M, Yamamoto T (2015) Characteristics of colonic diverticulitis and factors associated with complications: a Japanese Multicenter, Retrospective, cross-sectional study. Dis Colon Rectum 58:1174–1181
doi: 10.1097/DCR.0000000000000488
pubmed: 26544815
Kim SH, Byun CG, Cha JW, Choi SH, Kho YT, Seo DY (2010) Comparative study of the clinical features and treatment for right and left colonic diverticulitis. J Korean Soc Coloproctol 26:407–412
doi: 10.3393/jksc.2010.26.6.407
pubmed: 21221241
pmcid: 3017976
Mai CM, Wen CC, Wen SH, Hsu KF, Wu CC, Jao SW, Hsiao CW (2010) Iatrogenic colonic perforation by colonoscopy: a fatal complication for patients with a high anesthetic risk. Int J Colorectal Dis 25:449–454
doi: 10.1007/s00384-009-0822-z
pubmed: 19855987
Pox CP, Altenhofen L, Brenner H, Theilmeier A, Von Stillfried D, Schmiegel W (2012) Efficacy of a nationwide screening colonoscopy program for colorectal cancer. Gastroenterology 142:1460–1467
doi: 10.1053/j.gastro.2012.03.022
pubmed: 22446606
Korman LY, Overholt BF, Box T, Winker CK (2003) Perforation during colonoscopy in endoscopic ambulatory surgical centers. Gastrointest Endosc 58:554–557
doi: 10.1067/S0016-5107(03)01890-X
pubmed: 14520289
Rabeneck L, Paszat LF, Hilsden RJ, Saskin R, Leddin D, Grunfeld E, Wai E, Goldwasser M, Sutradhar R, Stukel TA (2008) Bleeding and perforation after outpatient colonoscopy and their risk factors in usual clinical practice. Gastroenterology 135:1899–1906
doi: 10.1053/j.gastro.2008.08.058
pubmed: 18938166
Lorenzo-Zuniga V, Moreno de Vega V, Domenech E, Manosa M, Planas R, Boix J (2010) Endoscopist experience as a risk factor for colonoscopic complications. Colorectal Dis 12:e273-277
doi: 10.1111/j.1463-1318.2009.02146.x
pubmed: 19930145