Endoscopic clip closure versus surgery for the treatment of iatrogenic colon perforations developed during diagnostic colonoscopy: A review of 115,285 patients

Background: Although the incidence of perforation after endoscopic procedures of the colon is low, the rising number of diagnostic colonoscopies could pose relevant health problems. Optimizing treatment may reduce the probability of severe complications. This study aimed to determine perforation frequency and the management of perforations that occurred during diagnostic colonoscopy. Methods: A retrospective review of patient records was performed for all patients with iatrogenic colonic perforations after sigmoidoscopy/ colonoscopy from 2000 to 2011 in three institutions of The Catholic University of Korea. The patients' demographic data, endoscopic procedure information, perforation location, therapy, and outcomes along with different therapeutic strategies were recorded. Results: In the 12-year period, a total of 115,285 diagnostic sigmoidoscopic/colonoscopic procedures were performed. A total of 27 perforations occurred. Sixteen patients underwent endoscopic clipping, of which three patients failed and were referred for surgery. Fourteen patients in total underwent surgery for perforation. Endoscopic clip closure was successful in 81 % of the patients. No perforation-related major morbidity or mortality occurred. Conclusion: Endoscopic repair using clips can be effective for the treatment of colon perforations that occur during diagnostic colonoscopy.