title: Iatrogenic perforation associated with therapeutic colonoscopy: a multicenter study in Japan.
abstract: OBJECTIVE
  Colonic perforation is the serious accidental complication. The aim of this study is to analyze the clinical presentation and management of recent iatrogenic perforations during therapeutic colonoscopy.
  
  
  METHODS
  Consecutive patients referred to four academic cancer centers in Japan were retrospectively reviewed using each center's endoscopy database of medical records. Data was obtained by means of an extensive data collection sheet. Since we evaluated the data including iatrogenic perforation during newly developed therapeutic procedure such as endoscopic submucosal dissection (ESD) or hemoclips, the collection of patient data was set from the period of the beginning of ESD technique in each hospital in this study.
  
  
  RESULTS
  The overall rate of occurrence of perforation was 0.15% (23/15, 160). Perforation rate for EMR (0.58%) showed a significantly higher rate (P < 0.0001) than that for hot biopsy and polypectomy. The rate for ESD (14%) showed a markedly higher rate (P < 0.0001) than that for other standard procedures. Of those perforations, endoscopic clipping was performed in 56.5% of the patients, and conservative treatment was successful in 100% of the patients with successful closure. Both CT scan findings and serology results (WBC, CRP) after perforation were poor predictors for need for surgery as opposed to conservative management.
  
  
  CONCLUSIONS
  Further improvements in EMR with special knife techniques are required to simply and safely remove large colorectal neoplasms, because perforation rate for ESD shows a markedly higher. Conservative management may be possible in patients who have undergone complete endoscopic clipping.
authors.affiliation: Division of Endoscopy and Gastrointestinal Oncology, National Cancer Center Hospital East, Chiba, Japan.
authors.forename: Keisei
authors.initials: K
authors.lastname: Taku
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Sano
authors.forename: Kuang-I
authors.initials: KI
authors.lastname: Fu
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Saito
authors.forename: Takahisa
authors.initials: T
authors.lastname: Matsuda
authors.forename: Toshio
authors.initials: T
authors.lastname: Uraoka
authors.forename: Takayuki
authors.initials: T
authors.lastname: Yoshino
authors.forename: Yuichirou
authors.initials: Y
authors.lastname: Yamaguchi
authors.forename: Mikio
authors.initials: M
authors.lastname: Fujita
authors.forename: Santa
authors.initials: S
authors.lastname: Hattori
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Ishikawa
authors.forename: Daizo
authors.initials: D
authors.lastname: Saito
authors.forename: Takahiro
authors.initials: T
authors.lastname: Fujii
authors.forename: Eizo
authors.initials: E
authors.lastname: Kaneko
authors.forename: Shigeaki
authors.initials: S
authors.lastname: Yoshida
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D003111:Colonic Polyps / Q000601:surgery; D003113:Colonoscopy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology*; D015994:Incidence; D007416:Intestinal Perforation / Q000453:epidemiology*; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged