Management of bleeding and perforation after colonoscopy

Abstract

Bleeding is a relatively rare complication occurring mainly after snare polypectomy. The majority of cases can be managed successfully by endoscopic means leaving very few cases which will ultimately need an operation. Colonic perforation, on the other hand is a serious complication that requires intensive and careful management. Prompt recognition of the perforation during the procedure allows, in selected cases, immediate endoscopic closure with an uneventful and full recovery followed by close monitoring and surgical management in case of clinical deterioration. The criteria for the right selection of perforation cases amenable to endoscopic treatment do still need to be confirmed by prospective studies and further experience is required before a standard algorithm on the endoscopic management of perforations is developed.

Keywords::

• colonoscopy complication
• endoscopic closure
• perforation
• postpolypectomy bleeding

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Bleeding is a relatively rare complication after colonoscopy occurring mostly after removal of colonic lesions and in the majority of the cases can be managed successfully by endoscopic means.

• Colon perforation, on the other hand, is a serious complication that requires intensive and careful management.

• Nowadays, prompt recognition of the perforation during the procedure allows in selected cases immediate endoscopic closure with an uneventful and full recovery, but it needs close monitoring by a multidisciplinary team in the immediate postprocedural period.

• Larger colon perforations or cases with failed endoscopic closure or deteriorating clinical condition require immediate surgical repair.