Our experience with endoscopic repair of large colonoscopic perforations and review of the literature

Abstract

Colonic perforation is the most severe complication of lower gastrointestinal endoscopy. Recently successful closure with endoscopic clips has been reported. However large (>10 mm) perforations and perforations occurring during diagnostic colonoscopy are considered a contraindication to endoscopic closure. We retrospectively reviewed our own experience with endoscopic closure of colonoscopic perforations. The size of the perforations was determined by comparison with the maximal opening of the clipping device. In addition we reviewed all cases of colonoscopic perforation published in the English language literature. From January 2006 we performed closure of three large colonoscopic perforations in three patients. One perforation occurred after en-bloc endoscopic mucosal resection of two polyps in the descending colon. The other two perforations occurred during diagnostic colonoscopy. All three cases were promptly diagnosed and successfully repaired with TriClips. Patients were kept on intravenous antibiotics and a clear liquid diet until bowel movement and were discharged between the 2nd and the 8th day after the procedure. A review of the literature, including our series, revealed 75 reported cases of colonoscopic perforations repaired with endoclips. Of these, four perforations were larger then 10 mm and four occurred during diagnostic colonoscopy. Of the perforations occurring during therapeutic colonoscopy, clip closure was carried out in 55-96% of the immediate perforations and was successful in 69-93% of cases. Nonsurgical management of colonoscopic perforations with endoclips is a highly feasible option. From our initial experience large perforations and perforations occurring during diagnostic colonoscopy are not a contraindication to endoscopic repair, but due to the small number of patients these data must be interpreted with caution.