Is endoscopic closure with clips effective for both diagnostic and therapeutic colonoscopy-associated bowel perforation?
BACKGROUND
Colonic perforation is an uncommon but serious colonoscopy-associated complication. This study assessed the effectiveness of conservative management with endoscopic clipping for colonoscopy-associated perforations.


METHODS
Clinical manifestations and management outcomes were assessed for 38 patients with colonoscopy-associated colonic perforations that occurred between January 2001 and April 2008 at the Asan Medical Center, Seoul, Korea. These perforations were classified as endoscopically evident, endoscopically suspected, and radiologically proven.


RESULTS
Of the 38 perforations, 19 were endoscopically evident, 9 were endoscopically suspected, and 10 were radiologically proven but without endoscopic evidence. Of the 19 patients with endoscopically evident perforations, 13 (68.4%) underwent endoscopic closure with clips, and all improved without surgery. All nine patients with endoscopically suspected perforations underwent endoscopic closure, and eight (88.9%) improved without surgery. Of the 10 radiologically proven perforations, 7 were detected within 1 day after colonoscopy. All the patients improved without surgery. However, two of the three patients with delayed perforations required emergency laparotomy. Consequently, of the 38 patients with perforations, 29 (76.3%) improved without surgery. Of the 28 patients with endoscopically evident or suspected perforations, conservative management was successful for 21 (95.5%) of the 22 patients with effective clipping, but for none (0%) of the 6 patients without clipping.


CONCLUSIONS
Conservative management by immediate endoscopic closure with clips can be effective for the treatment of colonic perforations detected during colonoscopy. Conservative management also may be tried cautiously for stable patients who have radiologically proven colonoscopy-associated perforations without endoscopic evidence.
Yang
Dong-Hoon
DH
Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap-2dong, Songpa-gu, Seoul 138-736, Korea.
Byeon
Jeong-Sik
JS
Lee
Kyung-Hoon
KH
Yoon
Soon Man
SM
Kim
Kyung Jo
KJ
Ye
Byong Duk
BD
Myung
Seung-Jae
SJ
Yang
Suk-Kyun
SK
Kim
Jin-Ho
JH
D003106:Colon / Q000293:injuries*; D003113:Colonoscopy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D007416:Intestinal Perforation / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D007723:Korea / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000379:methods*; D012189:Retrospective Studies; D012421:Rupture; D013536:Suture Techniques / Q000295:instrumentation*; D016896:Treatment Outcome