Iatrogenic perforation associated with therapeutic colonoscopy: A multicenter study in Japan
Keisei Taku
Division of Endoscopy and Gastrointestinal Oncology, National Cancer Center Hospital East, Chiba,
Search for more papers by this authorCorresponding Author
Yasushi Sano
Division of Endoscopy and Gastrointestinal Oncology, National Cancer Center Hospital East, Chiba,
Dr Yasushi Sano, National Cancer Center Hospital East, Division of Digestive Endoscopy and Gastrointestinal Oncology, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan. Email: [email protected]Search for more papers by this authorKuang-I Fu
Division of Endoscopy and Gastrointestinal Oncology, National Cancer Center Hospital East, Chiba,
Search for more papers by this authorYutaka Saito
Division of Endoscopy, National Cancer Center Hospital, Tokyo,
Search for more papers by this authorTakahisa Matsuda
Division of Endoscopy, National Cancer Center Hospital, Tokyo,
Search for more papers by this authorToshio Uraoka
Division of Endoscopy, National Cancer Center Hospital, Tokyo,
Search for more papers by this authorTakayuki Yoshino
Division of Endoscopy and Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka,
Search for more papers by this authorYuichirou Yamaguchi
Division of Endoscopy and Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka,
Search for more papers by this authorMikio Fujita
Department of Diagnostic Imaging, Division of Endoscopy, Tochigi Cancer Center Hospital, Tochigi, and
Search for more papers by this authorSanta Hattori
Division of Endoscopy and Gastrointestinal Oncology, National Cancer Center Hospital East, Chiba,
Search for more papers by this authorTsutomu Ishikawa
Department of Diagnostic Imaging, Division of Endoscopy, Tochigi Cancer Center Hospital, Tochigi, and
Search for more papers by this authorDaizo Saito
Division of Endoscopy, National Cancer Center Hospital, Tokyo,
Search for more papers by this authorTakahiro Fujii
Division of Endoscopy, National Cancer Center Hospital, Tokyo,
Search for more papers by this authorEizo Kaneko
Division of Gastroenterology, Seirei Hamamatsu General Hospital, Shizuoka, Japan
Search for more papers by this authorShigeaki Yoshida
Division of Endoscopy and Gastrointestinal Oncology, National Cancer Center Hospital East, Chiba,
Search for more papers by this authorKeisei Taku
Division of Endoscopy and Gastrointestinal Oncology, National Cancer Center Hospital East, Chiba,
Search for more papers by this authorCorresponding Author
Yasushi Sano
Division of Endoscopy and Gastrointestinal Oncology, National Cancer Center Hospital East, Chiba,
Dr Yasushi Sano, National Cancer Center Hospital East, Division of Digestive Endoscopy and Gastrointestinal Oncology, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan. Email: [email protected]Search for more papers by this authorKuang-I Fu
Division of Endoscopy and Gastrointestinal Oncology, National Cancer Center Hospital East, Chiba,
Search for more papers by this authorYutaka Saito
Division of Endoscopy, National Cancer Center Hospital, Tokyo,
Search for more papers by this authorTakahisa Matsuda
Division of Endoscopy, National Cancer Center Hospital, Tokyo,
Search for more papers by this authorToshio Uraoka
Division of Endoscopy, National Cancer Center Hospital, Tokyo,
Search for more papers by this authorTakayuki Yoshino
Division of Endoscopy and Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka,
Search for more papers by this authorYuichirou Yamaguchi
Division of Endoscopy and Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka,
Search for more papers by this authorMikio Fujita
Department of Diagnostic Imaging, Division of Endoscopy, Tochigi Cancer Center Hospital, Tochigi, and
Search for more papers by this authorSanta Hattori
Division of Endoscopy and Gastrointestinal Oncology, National Cancer Center Hospital East, Chiba,
Search for more papers by this authorTsutomu Ishikawa
Department of Diagnostic Imaging, Division of Endoscopy, Tochigi Cancer Center Hospital, Tochigi, and
Search for more papers by this authorDaizo Saito
Division of Endoscopy, National Cancer Center Hospital, Tokyo,
Search for more papers by this authorTakahiro Fujii
Division of Endoscopy, National Cancer Center Hospital, Tokyo,
Search for more papers by this authorEizo Kaneko
Division of Gastroenterology, Seirei Hamamatsu General Hospital, Shizuoka, Japan
Search for more papers by this authorShigeaki Yoshida
Division of Endoscopy and Gastrointestinal Oncology, National Cancer Center Hospital East, Chiba,
Search for more papers by this authorAbstract
Background and Aim: Colonic perforation is the serious accidental complication. The aim of this study is to analyze the clinical presentation and management of recent iatrogenic perforations during therapeutic colonoscopy.
Methods: Consecutive patients referred to four academic cancer centers in Japan were retrospectively reviewed using each center's endoscopy database of medical records. Data was obtained by means of an extensive data collection sheet. Since we evaluated the data including iatrogenic perforation during newly developed therapeutic procedure such as endoscopic submucosal dissection (ESD) or hemoclips, the collection of patient data was set from the period of the beginning of ESD technique in each hospital in this study.
Results: The overall rate of occurrence of perforation was 0.15% (23/15, 160). Perforation rate for EMR (0.58%) showed a significantly higher rate (P < 0.0001) than that for hot biopsy and polypectomy. The rate for ESD (14%) showed a markedly higher rate (P < 0.0001) than that for other standard procedures. Of those perforations, endoscopic clipping was performed in 56.5% of the patients, and conservative treatment was successful in 100% of the patients with successful closure. Both CT scan findings and seology results (WBC, CRP) after perforation were poor predictors for need for surgery as opposed to conservative management.
Conclusions: Further improvements in EMR with special knife techniques are required to simply and safely remove large colorectal neoplasms, because perforation rate for ESD shows a markedly higher. Conservative management may be possible in patients who have undergone complete endoscopic clipping.
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