Advertisement

Techniques in Coloproctology

, Volume 23, Issue 7, pp 681–685 | Cite as

Hospital management of colonic perforations complicating ambulatory outpatient colonoscopy via over-the-scope clips or surgery: a case series

  • S. Daher
  • T. KhouryEmail author
  • A. A. Benson
  • E. Tsvang
  • R. Elazary
  • H. Jacob
Original Article

Abstract

Background

Colonoscopy is the standard of care for the diagnosis and treatment of many colonic disorders. Over the past few years, endoscopic closure of colonoscopy-related perforation has become more common. Endoscopic closure of perforation secondary to colonoscopy has been undertaken in patients in the hospital setting and often during the same colonoscopic procedure in which the perforation itself occurred. The aim of our study was to analyze our experience with emergency endoscopic closure of colonoscopy-related perforation with over-the-scope clip (OTSC) technique.

Methods

We report five cases of colonic perforation that occurred during colonoscopy in an outpatient facility remotely located from our hospital and then referred as an emergency to our institution for endoscopic closure.

Results

Bowel preparation was reported to be adequate in all cases. Prior to attempting endoscopic closure of colonic perforation, all patients were in stable clinical condition, early broad-spectrum antibiotic coverage was initiated, and a surgical consult was obtained. All patients had sigmoidoscopy and were found to have sigmoid colon perforations. In three cases, the perforations were closed successfully using an OTSC clip device 14 mm type t. Two patients were found to have greater than 4-cm sigmoid perforations with irregular margins, incompatible with OTSC closure, and were referred for emergency surgery. All patients had an uneventful course following either OTSC closure or surgery.

Conclusions

Based on the characteristics of the five cases and a review of the literature, we suggest a practical approach for undertaking closure of colonic perforations occurring during colonoscopy in the outpatient setting, focusing on clinical criteria to determine eligibility of patients for attempted endoscopic closure and outlining required therapeutic and monitoring steps needed to optimize outcomes.

Keywords

Outpatients Setting Colonoscopy Perforation Closure 

Notes

Author contributions

SD and TK contributed to concept, review of literature, drafting of the manuscript and approval of the final manuscript. AAB, ET and RE contributed to technical support, critical revision of the manuscript. HJ: concept, technical support, and critical revision of the manuscript.

Funding

None

Compliance with ethical standards

Conflict of interest

The authors declare no conflict of interest regarding this manuscript.

Ethical approval

The study was approved by the local institutional ethic committee.

Informed consent

Written informed consent was obtained from all participants.

References

  1. 1.
    Haito-Chavez Y, Law JK, Kratt T, Arezzo A, Verra M, Morino M, Sharaiha RZ, Poley JW, Kahaleh M, Thompson CC, Ryan MB, Choksi N, Elmunzer BJ, Gosain S, Goldberg EM, Modayil RJ, Stavropoulos SN, Schembre DB, DiMaio CJ, Chandrasekhara V, Hasan MK, Varadarajulu S, Hawes R, Gomez V, Woodward TA, Rubel-Cohen S, Fluxa F, Vleggaar FP, Akshintala VS, Raju GS, Khashab MA (2014) International multicenter experience with an over-the-scope clipping device for endoscopic management of GI defects (with video). Gastrointest Endosc 80(4):610–622.  https://doi.org/10.1016/j.gie.2014.03.049 CrossRefGoogle Scholar
  2. 2.
    Orsoni P, Berdah S, Verrier C, Caamano A, Sastre B, Boutboul R, Grimaud JC, Picaud R (1997) Colonic perforation due to colonoscopy: a retrospective study of 48 cases. Endoscopy 29(3):160–164.  https://doi.org/10.1055/s-2007-1004156 CrossRefPubMedGoogle Scholar
  3. 3.
    Taku K, Sano Y, Fu KI, Saito Y (2006) Iatrogenic perforation at therapeutic colonoscopy: should the endoscopist attempt closure using endoclips or transfer immediately to surgery? Endoscopy 38(4):428.  https://doi.org/10.1055/s-2006-925248 CrossRefPubMedGoogle Scholar
  4. 4.
    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(5):464–466CrossRefPubMedGoogle Scholar
  5. 5.
    Mana F, De Vogelaere K, Urban D (2001) Iatrogenic perforation of the colon during diagnostic colonoscopy: endoscopic treatment with clips. Gastrointest Endosc 54(2):258–259CrossRefPubMedGoogle Scholar
  6. 6.
    Mangiavillano B, Arena M, Masci E (2014) Treatment of a sigmoid perforation with an over-the-scope clip during diagnostic colonoscopy. Clin Gastroenterol Hepatol 12(6):xxi–xxii.  https://doi.org/10.1016/j.cgh.2013.11.019 CrossRefPubMedGoogle Scholar
  7. 7.
    Lee SH, Cheong YS (2012) Successful endoscopic repair of an iatrogenic colonic perforation during diagnostic colonoscopy. J Am Board Fam Med 25(3):383–389.  https://doi.org/10.3122/jabfm.2012.03.110070 CrossRefPubMedGoogle Scholar
  8. 8.
    Mangiavillano B, Viaggi P, Masci E (2010) Endoscopic closure of acute iatrogenic perforations during diagnostic and therapeutic endoscopy in the gastrointestinal tract using metallic clips: a literature review. J Dig Dis 11(1):12–18.  https://doi.org/10.1111/j.1751-2980.2009.00414.x CrossRefGoogle Scholar
  9. 9.
    Voermans RP, Le Moine O, von Renteln D, Ponchon T, Giovannini M, Bruno M, Weusten B, Seewald S, Costamagna G, Deprez P, Fockens P, Group CS (2012) Efficacy of endoscopic closure of acute perforations of the gastrointestinal tract. Clin Gastroenterol Hepatol 10(6):603–608.  https://doi.org/10.1016/j.cgh.2012.02.005 CrossRefGoogle Scholar
  10. 10.
    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(7):701–706.  https://doi.org/10.1001/archsurg.143.7.701 (discussion 706–707) CrossRefPubMedGoogle Scholar
  11. 11.
    Luning TH, Keemers-Gels ME, Barendregt WB, Tan AC, Rosman C (2007) Colonoscopic perforations: a review of 30,366 patients. Surg Endosc 21(6):994–997.  https://doi.org/10.1007/s00464-007-9251-7 CrossRefGoogle Scholar
  12. 12.
    Paspatis GA, Dumonceau JM, Barthet M, Meisner S, Repici A, Saunders BP, Vezakis A, Gonzalez JM, Turino SY, Tsiamoulos ZP, Fockens P, Hassan C (2014) Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 46(8):693–711.  https://doi.org/10.1055/s-0034-1377531 CrossRefGoogle Scholar
  13. 13.
    Committee ASoP, Fisher DA, Maple JT, Ben-Menachem T, Cash BD, Decker GA, Early DS, Evans JA, Fanelli RD, Fukami N, Hwang JH, Jain R, Jue TL, Khan KM, Malpas PM, Sharaf RN, Shergill AK, Dominitz JA (2011) Complications of colonoscopy. Gastrointest Endosc 74(4):745–752.  https://doi.org/10.1016/j.gie.2011.07.025 CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • S. Daher
    • 1
  • T. Khoury
    • 1
    • 3
    • 4
    Email author
  • A. A. Benson
    • 1
  • E. Tsvang
    • 1
  • R. Elazary
    • 2
  • H. Jacob
    • 1
  1. 1.Division of Medicine, Institute of Gastroenterology and Liver DiseaseHadassah-Hebrew University Medical CenterJerusalemIsrael
  2. 2.Department of General SurgeryHadassah-Hebrew University Medical CenterJerusalemIsrael
  3. 3.Department of GastroenterologyGalilee Medical CenterNahariyaIsrael
  4. 4.Faculty of Medicine in the GalileeBar-Ilan UniversitySafedIsrael

Personalised recommendations