title: Clipping for endoscopic perforations: initial success but late complication requiring surgery.
abstract: BACKGROUND
  This response discusses the article by Kim and colleagues entitled "endoscopic clip closure versus surgery for the treatment of iatrogenic colon perforations developed during diagnostic colonoscopy: a review of 115,285 patients". Iatrogenic colonoscopic perforation, although uncommon, implies serious management problems for endoscopists and surgeons. Nonoperative treatment currently is recommended under certain conditions, and endoscopic clips can primarily close iatrogenic perforations, helping to avoid surgery. Of the 27 colonoscopic perforation cases presented in the article by Kim and colleagues, 16 were managed by endoscopic clipping closure and 11 by primary surgery. Conservative treatment failed for three patients. Only perforation size obtained statistical significance among the nine variables contrasted between the 11 cases with primary surgery and the 13 cases with successful endoscopic clipping. The results for the three patients whose endoscopic closure failed are not reported.
  The authors of this letter think it would have been interesting if these three patients had been included in the analysis due to the high importance of discovering factors that can predict failure of endoscopic clipping for perforations.
  
  
  CONCLUSIONS
  To call attention to possible late complications requiring surgery even when initial conservative management of endoscopic perforation succeeds, the authors of this letter present a case of a colocutaneous (actually, sigmoid-scrotal) fistula in a patient 2 weeks after an apparently successful closure of colonoscopic perforation with an "over-the-scope" clip.
authors: General and Digestive Surgery Department, Rio Hortega University Hospital, Valladolid, Spain, mariorodriguezlopez@yahoo.es.
authors: Mario
authors: M
authors: Rodriguez Lopez
authors: Jose I
authors: JI
authors: Blanco
authors: Ruth
authors: R
authors: Martinez
authors: Marta
authors: M
authors: Gonzalo
authors: Rosalia
authors: R
authors: Velasco
authors: Sara
authors: S
authors: Mambrilla
authors: Rafael
authors: R
authors: Ruiz-Zorrilla
authors: Jose C
authors: JC
authors: Sarmentero
authors: Enrique
authors: E
authors: Asensio
authors: Fernando
authors: F
authors: Labarga
authors: Baltasar
authors: B
authors: Perez-Saborido
authors: Jose L
authors: JL
authors: Marcos
mesh_terms: D003106:Colon / Q000293:injuries* / Q000601:surgery*; D003113:Colonoscopy; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000601:surgery*; D008297:Male
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