title: Colonoscopy-associated perforation: a 7-year survey of in-hospital frequency, treatment and outcome in a German university hospital.
abstract: OBJECTIVE
  Perforation occurs rarely after colonoscopy, but is associated with high morbidity and mortality. In this study, we assessed the perforation rate in our hospital, its clinical diagnosis and the long-term outcome.
  
  
  METHODS
  During the study period, 7535 examinations were performed, of which 4830 were diagnostic and 2705 therapeutic. The latter included polypectomy, endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), dilatation and argon plasma coagulation (APC).
  
  
  RESULTS
  Overall, 25 (0.33%) perforations occurred with two (0.026%) procedure-related deaths. Seven (0.14%) perforations occurred during a diagnostic procedure and 18 (0.67%) occurred during a therapeutic procedure. Dilation, submusous resection (SMR) and APC accounted for more perforations than polypectomy or diagnostic colonoscopy. Pre-existing gastrointestinal disease was present in 24 (96%) perforations. Three (12%) patients were treated conservatively and 22 (88%) underwent surgery. The site of perforation was closed by suture in four (18%) patients and resected with colonic anastomosis in five (23%) patients. Two patients underwent endoscopic clipping. A stoma was created after resection in 13 (59%) patients.
  
  
  CONCLUSIONS
  Death from perforation after colonoscopy is rare, occurring in 1/3500 examinations. The risk is increased in therapeutic colonoscopy and in the presence of previous gastrointestinal disease. Dilatation, SMR and APC appeared to confer a higher risk of perforation than polypectomy or diagnostic colonoscopy.
authors: Department of Medicine I, University of Erlangen, Erlangen, Germany. alexander.hagel@uk-erlangen.de
authors: A F
authors: AF
authors: Hagel
authors: F
authors: F
authors: Boxberger
authors: W
authors: W
authors: Dauth
authors: H P
authors: HP
authors: Kessler
authors: M F
authors: MF
authors: Neurath
authors: M
authors: M
authors: Raithel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057908:Argon Plasma Coagulation / Q000009:adverse effects; D003113:Colonoscopy / Q000009:adverse effects*; D004210:Dissection / Q000009:adverse effects; D005260:Female; D005858:Germany; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007410:Intestinal Diseases / Q000150:complications; D007416:Intestinal Perforation / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012307:Risk Factors