TY - JOUR

T1 - Endoscopic treatment of colorectal perforations – a systematic review

AU - Hassan, Mohamed Ali

AU - Thomsen, Christian Øystein

AU - Vilmann, Peter

PY - 2016/4

Y1 - 2016/4

N2 - INTRODUCTION: Iatrogenic colon perforation is a feared complication to colonoscopy. Optimal management of the complication remains controversial. Traditionally, patients have been referred to surgery. Now, with technological advances, endoscopic closure is increasingly performed as minimally invasive therapy. The aim of this systematic review was to assess the existing evidence in this field.METHODS: Literature was searched on PubMed, Embase and the Cochrane databases. Papers found were reported according to the PRISMA guidelines. Trials on animals were excluded.RESULTS: A total of 32 articles were assessed, including 19 case reports, one case control, three prospective studies and nine retrospective studies. The total number of patients who have undergone endoscopic closure (apart from case reports) and reported in the literature is 203 patients. Studies have reported a clinical success rate of 87.8% (standard deviation: ± 13.0%) on average and a median of 92.3% (range: 58.6-100%). The total number of patients needing surgery after attempted clip closure was 30 (14.7%); another four were found to have sealed perforations during surgery. One patient died after clip failure (0.5%). Articles presented a favourable, high outcome for endoscopic closure of iatrogenic colorectal perforations.CONCLUSION: In a highly selective group of patients, endoscopic closure of iatrogenic colon perforations is recommended if the expertise is available.

AB - INTRODUCTION: Iatrogenic colon perforation is a feared complication to colonoscopy. Optimal management of the complication remains controversial. Traditionally, patients have been referred to surgery. Now, with technological advances, endoscopic closure is increasingly performed as minimally invasive therapy. The aim of this systematic review was to assess the existing evidence in this field.METHODS: Literature was searched on PubMed, Embase and the Cochrane databases. Papers found were reported according to the PRISMA guidelines. Trials on animals were excluded.RESULTS: A total of 32 articles were assessed, including 19 case reports, one case control, three prospective studies and nine retrospective studies. The total number of patients who have undergone endoscopic closure (apart from case reports) and reported in the literature is 203 patients. Studies have reported a clinical success rate of 87.8% (standard deviation: ± 13.0%) on average and a median of 92.3% (range: 58.6-100%). The total number of patients needing surgery after attempted clip closure was 30 (14.7%); another four were found to have sealed perforations during surgery. One patient died after clip failure (0.5%). Articles presented a favourable, high outcome for endoscopic closure of iatrogenic colorectal perforations.CONCLUSION: In a highly selective group of patients, endoscopic closure of iatrogenic colon perforations is recommended if the expertise is available.

KW - Colon

KW - Colonoscopy

KW - Endoscopy, Digestive System

KW - Humans

KW - Intestinal Perforation

KW - Rectum

KW - Treatment Outcome

KW - Journal Article

KW - Review

M3 - Review

C2 - 27034185

VL - 63

JO - Danish Medical Journal

JF - Danish Medical Journal

SN - 2245-1919

IS - 4

M1 - A5220

ER -