title: Clinical outcomes and direct costings of endoluminal clipping compared to surgery in the management of iatrogenic colonic perforation.
abstract: OBJECTIVE
  To compare the outcomes and costs of endoluminal clipping and surgery in the management of iatrogenic colonic perforation.
  
  
  METHODS
  A retrospective, single-center, clinical and economic analysis of outcomes and costings between endoluminal clipping and surgery in consecutive cases of iatrogenic colonic perforations was conducted.
  
  
  RESULTS
  In total, 7136 colonoscopies performed over a 6-year period were complicated by 12 (0.17%) perforations. Seven cases were treated by endoscopic clipping (with a success rate of 71.4%) and five with immediate surgery. Both groups of patients had similar clinical and individual characteristics. Patients who were treated with endoscopic clipping had a shorter period of hospitalization (median 9 vs 13 days) compared to surgery, but this was not statistically significant. Compared to patients who had immediate surgery, the median direct health-care costs for all procedures (US$ 115.10 vs US$ 1479.50, P = 0.012) and investigations (US$ 124.60 vs US$ 512.90, P = 0.048) during inpatient stay were lower for the endoscopic clipping group. There was a trend towards a lower overall inpatient median cost for patients managed with endoscopic clipping compared to surgery (US$ 1481.70 vs US$ 3281.90, P = 0.073).
  
  
  CONCLUSIONS
  Endoluminal clipping may be more cost-effective than surgery in the management of iatrogenic colonic perforations.
authors: Division of Gastroenterology, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors: Wah-Kheong
authors: WK
authors: Chan
authors: April Camilla
authors: AC
authors: Roslani
authors: Chee-Wei
authors: CW
authors: Law
authors: Khean-Lee
authors: KL
authors: Goh
authors: Sanjiv
authors: S
authors: Mahadeva
mesh_terms: D000368:Aged; D003106:Colon / Q000293:injuries* / Q000601:surgery; D003113:Colonoscopy / Q000009:adverse effects* / Q000191:economics / Q000379:methods; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006295:Health Resources / Q000706:statistics & numerical data; D006801:Humans; D007049:Iatrogenic Disease / Q000191:economics*; D007416:Intestinal Perforation / Q000191:economics / Q000209:etiology / Q000601:surgery*; D008296:Malaysia; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013536:Suture Techniques / Q000191:economics; D016896:Treatment Outcome
keywords: colonoscopy; colorectal surgery; direct costing; endoscopic clipping; perforation