title: Endoscopic management of iatrogenic perforations during endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) for colorectal polyps: a case series.
abstract: BACKGROUND
  Iatrogenic perforation during therapeutic colonoscopy, reported in up to 1% of endoscopic mucosal resections (EMRs) and up to 14% of endoscopic submucosal dissections (ESDs), has conventionally been an indication for surgery.
  
  
  OBJECTIVE
  We present a case series of successful endoscopic management of iatrogenic colorectal perforation during EMR and ESD, demonstrating the feasibility and safety of the method.
  
  
  METHODS
  Retrospective analysis of a database of patients undergoing EMR and ESD for colorectal polyps in a tertiary referral centre in the United Kingdom.
  
  
  RESULTS
  Four cases of perforation were identified (two EMRs and two ESDs) in a series of 218 procedures (1.8%), all detected at the time of endoscopy and managed with endoscopic clips. Patients were observed in hospital and treated with antibiotics. Their median length of stay was 3 days (range 2-6 days), with no mortality or need for surgery.
  
  
  CONCLUSIONS
  Surgery is no longer the first choice in the management of iatrogenic perforations during EMR and ESD for colorectal polyps; in selected patients with small perforations and minimal extraluminal contamination, conservative management with application of endoscopic clips, antibiotics and close patient monitoring constitute a safe and effective treatment option, avoiding the morbidity of major surgery.
authors.affiliation: Department of Colorectal Surgery and Endoscopy, King's College Hospital, Denmark Hill, London, UK.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Pissas
authors.affiliation: Department of Colorectal Surgery and Endoscopy, King's College Hospital, Denmark Hill, London, UK.
authors.forename: Efthymios
authors.initials: E
authors.lastname: Ypsilantis
authors.affiliation: Department of Colorectal Surgery and Endoscopy, King's College Hospital, Denmark Hill, London, UK.
authors.forename: Savvas
authors.initials: S
authors.lastname: Papagrigoriadis
authors.affiliation: Department of Colorectal Surgery and Endoscopy, King's College Hospital, Denmark Hill, London, UK.
authors.forename: Bu'Hussain
authors.initials: B
authors.lastname: Hayee
authors.affiliation: Department of Colorectal Surgery, Kings College Hospital, Denmark Hill, London SE5 9RS, UK.
authors.forename: Amyn
authors.initials: A
authors.lastname: Haji
keywords: EMR; ESD; colon; perforation; polyp; rectum