How Things Have Changed: Management of Colonoscopic Perforations
Douglas K. Rex, MD, MASGE, reviewing Paspatis GA, et al. Endosc Int Open 2021 May 27.
Fifteen years ago, tools to close acute perforations during colonoscopy became available, beginning with hemostatic clips, followed by over-the-scope clips and suturing.
To examine the impact of closure tools on the management of colonoscopic perforation, investigators from Greece divided their experience into 2 periods: July 1996 to December 2012 and January 2013 to March 2020. There were 15 perforations in the first period and 11 in the second period. Of the 26 perforations, 17 were related to instrument passage and 9 to therapeutic colonoscopies. Interestingly, all but 3 perforations occurred in females. In the first period, surgery was performed in 93% of patients, compared to 27% in the second period. Hospitalization duration decreased from 6.9 days to 4 days from period 1 to period 2. Over-the-scope clips were used in 5 cases and were uniformly successful, whereas through-the-scope clips failed in 1 of 2 cases.
COMMENTThese results emphasize that when a colonoscopic perforation occurs and is immediately recognized, we should determine how to achieve endoscopic closure rather than instantly calling for surgery. In the handful of EMR-related acute perforations that have occurred in my experience, through-the-scope clips have been uniformly successful in the closure and prevention of surgery. Unquestionably, large diagnostic perforations require over-the-scope clips or suturing.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
CITATION(S)
Paspatis GA, Fragaki M, Velegraki M, et al. Paradigm shift in management of acute iatrogenic colonic perforations: 24-year retrospective comprehensive study. Endosc Int Open 2021;9:E874-E880. (https://doi.org/10.1055/a-1396-4086)
