Risk factors and management of iatrogenic colorectal perforation in diagnostic colonoscopy: a single-center cohort study

Abstract

Background and aims

Diagnostic colonoscopy plays a central role in colorectal cancer screening programs. We analyzed the risk factors for perforation during diagnostic colonoscopy and discussed the treatment outcomes.

Methods

We performed a retrospective analysis of risk factors and treatment outcomes of perforation during 74,426 diagnostic colonoscopies between 2013 and 2018 in a tertiary hospital.

Results

A total of 19 perforations were identified after 74,426 diagnostic colonoscopies or sigmoidoscopies, resulting in a standardized incidence rate of 0.025% or 2.5 per 10,000 colonoscopies. The majority (15 out of 19, 79%) were found at the sigmoid colon and recto-sigmoid junction. Perforation occurred mostly in less than 1000 cases of colonoscopy (16 out of 19, 84%). In particular, the incidence of perforation was higher in more than 200 cases undergoing slightly advanced colonoscopy rather than beginners who had just learned colonoscopy. Old age (≥ 70 years), inpatient setting, low body mass index (BMI), and sedation status were significantly associated with increased risk of perforation. Nine (47%) of the patients underwent operative treatment and ten (53%) were managed non-operatively. Patients who underwent surgery were often diagnosed with delayed or concomitant abdominal pain. Perforations of rectum tended to be successfully treated with endoscopic clipping.

Conclusions

Additional precautions are required to prevent perforation in elderly patients, hospital settings, low BMI, sedated patients, or by a doctor with slight familiarity with endoscopies (but still insufficient experience). Endoscopic treatment should be actively considered if diagnosis is prompt, abdominal pain absent, and especially the rectal perforation is present.

Keywords:

• Iatrogenic perforation
• diagnostic colonoscopy
• risk factor endoscopic treatment

Author contributions

Conceptualization: Eun Ran Kim. Methodology: Aryoung Kim, Heejung Kim, Eun Ran Kim, Ji Eun Kim, Sung Noh Hong, Dong Kyung Chang and Young-Ho Kim. Formal analysis: Aryoung Kim, Heejung Kim. Project administration: Aryoung Kim, Heejung Kim, Eun Ran Kim. Visualization: Aryoung Kim, Heejung Kim. Writing – original draft: Aryoung Kim, Heejung Kim. Writing – review and editing: Aryoung Kim, Eun Ran Kim, Ji Eun Kim, Sung Noh Hong, Dong Kyung Chang and Young-Ho Kim. Approval of final manuscript: all authors.

Disclosure statement

The authors have no conflicts of interest to declare.

Data availability statement

The data analyzed in this article cannot be shared publicly, given the privacy of the individuals who participated in the study. However, the data will be shared upon reasonable request to the corresponding author.