Post written by Mark Benson, MD, from the University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.

Colonoscopy is one of the most common endoscopic procedures completed throughout the world.  Although rare, procedure-related perforations are one of the most feared adverse events of colonoscopy because of the potential for unfavorable patient outcomes.

The focus of this Top Tips article was to provide a brief update on the management of iatrogenic perforations of the colon. I wanted to highlight some of the proven endoscopic techniques known to decrease the risk of perforation when introducing the colonoscope or resecting large colon polyps. 

In addition, I wanted to offer a concise review of the management possibilities including endoscopic closure. Lastly, I wished to remind endoscopists of the need for prompt recognition of those patients who will require an operative repair. 

Two years ago, I delivered a talk on colon perforations at Digestive Disease Week. In the wake of that lecture, several providers from other institutions reached out to me with further questions about endoscopic repairs. 

In the correct setting, endoscopic closure is technically successful >90%¹ of the time with through-the-scope or over-the-scope clips and can avoid the need for surgery. Most proficient endoscopists have the skillset necessary and tools available to close small iatrogenic colon perforations. 

As endoscopic instruments and devices continue to advance, so too will the ability to treat these types of adverse events. I am hopeful this brief Top Tips review will help guide endoscopists to better manage these unfortunate adverse events and improve patient care. I encourage providers to please contact me with additional questions.

Place the through-the-scope clips perpendicular to the perforation, and try to place them adjacent to each other in a linear fashion to ensure adequate mucosal closure. (Illustration courtesy of Leela Benson.)

Read the full article online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

1. Paspatis GA, Dumonceau J-M, Barthet, M, et al. Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) position statement. Endoscopy 2014;46:693-711. ↩︎