3351 Iatrogenic perforation in diagnostic colonoscopy related to the type of sedation.

Abstract

INTRODUCTION: Diagnostic colonoscopy is a safe procedure, although a iatrogenic perforation rate ranging from 0.04% to 0.9% has been reported by different authors. The influence of deep sedation in the occurrence of this complication remains controversial as it eliminates pain due to excessive insuflation and endoscope loop formation, both potential causes of colonic perforation. The aim of this study is to evaluate the incidence of colonic perforation during diagnostic colonoscopy and the role of the type of sedation. MATERIAL AND METHOD: 7.286 consecutive diagnostic colonoscopies performed during a 3 year period were included in the study. Patients were randomized to undergo deep sedation with propofol I.V. (Group A; n = 4.005) or conscious sedation with diazepan I.V. (Group B; n = 3.281). Therapeutic colonoscopies were excluded from the protocol. Incidence of iatrogenic perforation was analyzed in both groups, evaluating patients characteristics and both endoscopist (senior/trainee) and endoscopy assistant experience. Fisher test was used for statistical analysis. RESULTS: 7 perforations took place in group A (0.17%) and 2 in group B (0.06%) (p=0.03). Among those perforations in group A, 6 of them (0.32%) occured during the first 18 months of the study, whereas only one (0.04%) occured during the following 18 months (p = 0.06). No significant differences were found concerning patient characteristics or experience of the endoscopy team. CONCLUSIONS: 1. Diagnostic colonoscopy performance under deep sedation has a higher rate of iatrogenic perforation although without statistical significance. 2. As this increment concentrates within the initial period of using deep sedation, extreme caution must be taken until experience is acquired in order to avoid this complication. INTRODUCTION: Diagnostic colonoscopy is a safe procedure, although a iatrogenic perforation rate ranging from 0.04% to 0.9% has been reported by different authors. The influence of deep sedation in the occurrence of this complication remains controversial as it eliminates pain due to excessive insuflation and endoscope loop formation, both potential causes of colonic perforation. The aim of this study is to evaluate the incidence of colonic perforation during diagnostic colonoscopy and the role of the type of sedation. MATERIAL AND METHOD: 7.286 consecutive diagnostic colonoscopies performed during a 3 year period were included in the study. Patients were randomized to undergo deep sedation with propofol I.V. (Group A; n = 4.005) or conscious sedation with diazepan I.V. (Group B; n = 3.281). Therapeutic colonoscopies were excluded from the protocol. Incidence of iatrogenic perforation was analyzed in both groups, evaluating patients characteristics and both endoscopist (senior/trainee) and endoscopy assistant experience. Fisher test was used for statistical analysis. RESULTS: 7 perforations took place in group A (0.17%) and 2 in group B (0.06%) (p=0.03). Among those perforations in group A, 6 of them (0.32%) occured during the first 18 months of the study, whereas only one (0.04%) occured during the following 18 months (p = 0.06). No significant differences were found concerning patient characteristics or experience of the endoscopy team. CONCLUSIONS: 1. Diagnostic colonoscopy performance under deep sedation has a higher rate of iatrogenic perforation although without statistical significance. 2. As this increment concentrates within the initial period of using deep sedation, extreme caution must be taken until experience is acquired in order to avoid this complication.