Endoscopic perforation of the colon: Lessons from a 10-year study

Monte L. Anderson, Tousif M. Pasha, Jonathan A Leighton

Research output: Contribution to journalArticle

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Abstract

OBJECTIVES: To assess the incidence, clinical features, and management of endoscopic colon perforations in a large number of patients at a major medical teaching center. METHODS: A retrospective review of medical records of all patients with colon perforations from endoscopy over a 10-yr period. RESULTS: A total of 10,486 colonoscopies were performed over a 10-yr period. There were 20 (0.19%) perforations and two (0.019%) deaths related to colonoscopy and two perforations with no deaths in 49,501 sigmoidoscopies (0.004%). The majority of perforations (65%) occurred in the sigmoid colon. The mean age of the patients was 72 yr (range, 48-87 yr). Multivariate analysis using gender and age showed that female gender was an independent predictor of a higher risk of perforation (p < 0.05). Electrocautery injury (36%) and mechanical injury (32%) from the tip and shaft of the endoscope were the major causes for perforation. Most patients (91%) presented within 48 h of endoscopy. Nine patients (47%) required a surgical resection with primary anastomosis; seven (37%) required a simple closure. The average hospital length of stay was 7.7 ± 2.8 days. Although trainee endoscopists were involved in only 20% of the colonoscopies performed, eight (40%) perforations occurred while the training fellow was involved in the case. However, this increased risk of perforation with a training fellow was not statistically significant (p = 0.625). CONCLUSIONS: Colonoscopy can result in significant morbidity and carries a small risk of death. Sigmoidoscopy has lower risk. The following situations may represent increased risk to colonoscopy patients: unusual difficulty in traversing the sigmoid colon; difficult examinations in female patients, and difficult examinations performed by trainee physicians.

Original languageEnglish (US)
Pages (from-to)3418-3422
Number of pages5
JournalAmerican Journal of Gastroenterology
Volume95
Issue number12
DOIs
StatePublished - 2000

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Colon
Colonoscopy
Sigmoidoscopy
Sigmoid Colon
Endoscopy
Length of Stay
Electrocoagulation
Endoscopes
Wounds and Injuries
Medical Records
Teaching
Multivariate Analysis
Morbidity
Physicians
Incidence

ASJC Scopus subject areas

  • Gastroenterology

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Endoscopic perforation of the colon : Lessons from a 10-year study. / Anderson, Monte L.; Pasha, Tousif M.; Leighton, Jonathan A.

In: American Journal of Gastroenterology, Vol. 95, No. 12, 2000, p. 3418-3422.

Research output: Contribution to journalArticle

Anderson, Monte L. ; Pasha, Tousif M. ; Leighton, Jonathan A. / Endoscopic perforation of the colon : Lessons from a 10-year study. In: American Journal of Gastroenterology. 2000 ; Vol. 95, No. 12. pp. 3418-3422.
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abstract = "OBJECTIVES: To assess the incidence, clinical features, and management of endoscopic colon perforations in a large number of patients at a major medical teaching center. METHODS: A retrospective review of medical records of all patients with colon perforations from endoscopy over a 10-yr period. RESULTS: A total of 10,486 colonoscopies were performed over a 10-yr period. There were 20 (0.19{\%}) perforations and two (0.019{\%}) deaths related to colonoscopy and two perforations with no deaths in 49,501 sigmoidoscopies (0.004{\%}). The majority of perforations (65{\%}) occurred in the sigmoid colon. The mean age of the patients was 72 yr (range, 48-87 yr). Multivariate analysis using gender and age showed that female gender was an independent predictor of a higher risk of perforation (p < 0.05). Electrocautery injury (36{\%}) and mechanical injury (32{\%}) from the tip and shaft of the endoscope were the major causes for perforation. Most patients (91{\%}) presented within 48 h of endoscopy. Nine patients (47{\%}) required a surgical resection with primary anastomosis; seven (37{\%}) required a simple closure. The average hospital length of stay was 7.7 ± 2.8 days. Although trainee endoscopists were involved in only 20{\%} of the colonoscopies performed, eight (40{\%}) perforations occurred while the training fellow was involved in the case. However, this increased risk of perforation with a training fellow was not statistically significant (p = 0.625). CONCLUSIONS: Colonoscopy can result in significant morbidity and carries a small risk of death. Sigmoidoscopy has lower risk. The following situations may represent increased risk to colonoscopy patients: unusual difficulty in traversing the sigmoid colon; difficult examinations in female patients, and difficult examinations performed by trainee physicians.",
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AB - OBJECTIVES: To assess the incidence, clinical features, and management of endoscopic colon perforations in a large number of patients at a major medical teaching center. METHODS: A retrospective review of medical records of all patients with colon perforations from endoscopy over a 10-yr period. RESULTS: A total of 10,486 colonoscopies were performed over a 10-yr period. There were 20 (0.19%) perforations and two (0.019%) deaths related to colonoscopy and two perforations with no deaths in 49,501 sigmoidoscopies (0.004%). The majority of perforations (65%) occurred in the sigmoid colon. The mean age of the patients was 72 yr (range, 48-87 yr). Multivariate analysis using gender and age showed that female gender was an independent predictor of a higher risk of perforation (p < 0.05). Electrocautery injury (36%) and mechanical injury (32%) from the tip and shaft of the endoscope were the major causes for perforation. Most patients (91%) presented within 48 h of endoscopy. Nine patients (47%) required a surgical resection with primary anastomosis; seven (37%) required a simple closure. The average hospital length of stay was 7.7 ± 2.8 days. Although trainee endoscopists were involved in only 20% of the colonoscopies performed, eight (40%) perforations occurred while the training fellow was involved in the case. However, this increased risk of perforation with a training fellow was not statistically significant (p = 0.625). CONCLUSIONS: Colonoscopy can result in significant morbidity and carries a small risk of death. Sigmoidoscopy has lower risk. The following situations may represent increased risk to colonoscopy patients: unusual difficulty in traversing the sigmoid colon; difficult examinations in female patients, and difficult examinations performed by trainee physicians.

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