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Ochi M, Yamamoto A, Suematsu S, Fukuda K, Morishige K, Oka Y, Ishikawa Y, Ueyama S, Hiroshima Y, Omae Y, Kusano F, Kamoshida T. High Joule heat as a risk factor for post-endoscopic submucosal dissection electrocoagulation syndrome: A multicenter prospective study. World J Gastrointest Endosc 2024; 16:668-677. [PMID: 39735389 PMCID: PMC11669959 DOI: 10.4253/wjge.v16.i12.668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Revised: 09/16/2024] [Accepted: 10/14/2024] [Indexed: 12/12/2024] Open
Abstract
BACKGROUND Thermal damage may lead to inflammation of the peeled mucosal surface during endoscopic submucosal dissection (ESD). AIM To determine the effect of Joule heat on the onset of post-ESD electrocoagulation syndrome (PECS). METHODS In this prospective study, PECS was characterized by in-hospital fever (white blood cell count: ≥ 10000 μ/L or body temperature ≥ 37.5 °C) and abdominal pain (visual analog scale score ≥ 30 mm during hospitalization or increased by ≥ 20 mm from baseline at admission). High Joule heat was defined as 15390 J. Between April 2020 and April 2024, 209 patients underwent colorectal ESD; those with intraoperative perforation or penetration were excluded. The remaining 202 patients were divided into the PECS and non-PECS groups. RESULTS PECS occurred in 30 (14.9%) patients. Multivariate analysis revealed high Joule heat as an independent factor associated with PECS (odds ratio = 7.96; 95% confidence interval: 2.91-21.8, P < 0.01). The procedure time and presence of lesions in the right colon were not associated with PECS. CONCLUSION Accumulated thermal damage on the peeled mucosal surface should be considered during PECS onset. This thermal damage is likely a major component of the mechanism underlying PECS.
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Affiliation(s)
- Masanori Ochi
- Department of Gastroenterology, Hitachi General Hospital, Ibaraki 317-0077, Japan
- Department of Gastroenterology, Institute of Medicine, University of Tsukuba, Tsukuba 305-8576, Japan
- Department of Gastroenterology, Shoujukai Medical Association, Kiyosumi-Shirakawa Family Clinic, Tokyo 135-0021, Japan
- Hitachi Society Cooperation Education Research Center, University of Tsukuba, Hitachi 317-0077, Japan
| | - Asaji Yamamoto
- Department of Gastroenterology, Hitachi General Hospital, Ibaraki 317-0077, Japan
| | - Satoshi Suematsu
- Department of Gastroenterology, Ome Medical Center, Tokyo 198-0042, Japan
| | - Keita Fukuda
- Department of Gastroenterology, Tsuchiura Kyodo General Hospital, Ibaraki 300-0028, Japan
| | - Kenjiro Morishige
- Department of Gastroenterology, Kawasaki Saiwai Hospital, Kanagawa 212-0014, Japan
| | - Yasuhiro Oka
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Tokyo 113-8677, Japan
| | - Yuta Ishikawa
- Department of Gastroenterology, Hitachi General Hospital, Ibaraki 317-0077, Japan
| | - Shunsuke Ueyama
- Department of Gastroenterology, Tsuchiura Kyodo General Hospital, Ibaraki 300-0028, Japan
| | - Yoshinori Hiroshima
- Department of Gastroenterology, Hitachinaka General Hospital, Ibaraki 312-0057, Japan
| | - Yoshio Omae
- Department of Gastroenterology, Kawasaki Saiwai Hospital, Kanagawa 212-0014, Japan
| | - Fumihiko Kusano
- Department of Gastroenterology, Tsuchiura Kyodo General Hospital, Ibaraki 300-0028, Japan
| | - Toshiro Kamoshida
- Department of Gastroenterology, Hitachi General Hospital, Ibaraki 317-0077, Japan
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Ohira K, Kawarada Y, Iwata R, Satake M. Fatal outcome of postpolypectomy syndrome: A case report. Radiol Case Rep 2024; 19:6131-6134. [PMID: 39364275 PMCID: PMC11447305 DOI: 10.1016/j.radcr.2024.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2024] [Revised: 08/26/2024] [Accepted: 09/02/2024] [Indexed: 10/05/2024] Open
Abstract
Postpolypectomy syndrome (PPS), also known as postpolypectomy coagulation syndrome or transmural burn syndrome, is a rare complication following colonic polypectomy characterized by abdominal pain, fever, and leukocytosis. Herein, we present a case of a patient in his 70s who developed abdominal pain and fever after a polypectomy. He was diagnosed with PPS, which rapidly progressed to septic shock necessitating left hemicolectomy. Pathological findings confirmed intestinal necrosis and severe electrocoagulation injury. Despite surgical intervention, the patient succum to multiple complications. While usually mild, approximately 0.07% of PPS cases require hospitalization due to localized peritonitis from electrocautery. Conservative management is effective, though severe complications are rare. Despite its generally favorable prognosis, our case highlights rapid progression to fatal septic shock postsurgery. Recognition of PPS is crucial, particularly in patients with abdominal pain postpolypectomy, as it can lead to life-threatening outcomes.
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Affiliation(s)
- Kenji Ohira
- Department of Radiology, Shin-Kuki General Hospital, 418-1 Kamihayami, Kuki City, Saitama Prefecture 346-8530, Japan
| | - Yo Kawarada
- Department of Radiology, Shin-Kuki General Hospital, 418-1 Kamihayami, Kuki City, Saitama Prefecture 346-8530, Japan
| | - Ryoko Iwata
- Department of Radiology, Shin-Kuki General Hospital, 418-1 Kamihayami, Kuki City, Saitama Prefecture 346-8530, Japan
| | - Mitsuo Satake
- Department of Radiology, Shin-Kuki General Hospital, 418-1 Kamihayami, Kuki City, Saitama Prefecture 346-8530, Japan
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Cohen S, Hyer W, Attard T. Endoscopy in pediatric polyposis syndromes: why, when and how. Eur J Gastroenterol Hepatol 2024; 36:255-263. [PMID: 38251433 DOI: 10.1097/meg.0000000000002702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Single or multiple polyps are frequently encountered during colonoscopy among children and adolescents and may be indicative of hereditary polyposis syndrome (HPS). The management of children with single or multiple polyps is guided by the number of polyps, their distribution and the histological findings. Children with HPS carry a high risk of complications, including intestinal and extra-intestinal malignancies. The goals of surveillance in pediatric HPS are to treat symptoms, monitor the burden of polyps and prevent short- and long-term complications. Therefore, the management of children with HPS is based on therapeutic endoscopy. The strategy of therapeutic endoscopy is a careful assessment and characterization of the polyps and performing polypectomies using advanced endoscopic techniques. A multidisciplinary approach, comprising clinical, interventional endoscopy, cancer surveillance and support of familial and emotional aspects is essential in the management of children with HPS.
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Affiliation(s)
- Shlomi Cohen
- Pediatric Gastroenterology Institute, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Warren Hyer
- St Mark's Hospital Polyposis Registry, Harrow, UK
| | - Thomas Attard
- Division of Gastroenterology, Hepatology and Nutrition, The University of Missouri in Kansas Division of Gastroenterology, Hepatology and Nutrition, City School of Medicine, Children's Mercy Hospital Kansas City, Missouri, USA
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Fusco S, Bauer ME, Schempf U, Stüker D, Blumenstock G, Malek NP, Werner CR, Wichmann D. Analysis of Predictors and Risk Factors of Postpolypectomy Syndrome. Diagnostics (Basel) 2024; 14:127. [PMID: 38248004 PMCID: PMC10814321 DOI: 10.3390/diagnostics14020127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 12/26/2023] [Accepted: 01/03/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND AND AIMS Postpolypectomy syndrome (PPS) is a relevant adverse event that can appear after polypectomy. Several publications mention postpolypectomy syndrome using different criteria to define it. The aim of this study is to detect potential risk factors and predictors for developing PPS and to define the main criteria of PPS. METHODS In this retrospective monocentric study, 475 out of 966 patients who underwent colonoscopy with polypectomy from October 2015 to June 2020 were included. The main criterion of PPS is defined as the development of postinterventional abdominal pain lasting more than six hours. RESULTS A total of 9.7% of the patients developed PPS, which was defined as local abdominal pain around the polypectomy area after six hours. A total of 8.6% of the study population had abdominal pain within six hours postintervention. A total of 3.7% had an isolated triad of fever, leukocytosis, and increased CRP in the absence of abdominal pain. Increased CRP combined with an elevated temperature over 37.5 °C seems to be a positive predictor for developing PPS. Four independent risk factors could be detected: serrated polyp morphology, polypoid configurated adenomas, polyp localization in the cecum, and the absence of intraepithelial neoplasia. CONCLUSIONS Four independent risk factors for developing PPS were detected. The combination of increased CRP levels with elevated temperature seems to be a predictor for this pathology. As expected, the increasing use of cold snare polypectomies will reduce the incidence of this syndrome. Key summary: Our monocentric study on 966 patients detected four independent risk factors for developing PPS: pedunculated polyp, resected polyps in the cecum, absence of IEN, and serrated polyp morphology. The combination of increased CRP levels with elevated temperature seems to be a predictor for this pathology.
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Affiliation(s)
- Stefano Fusco
- Department of Internal Medicine I, Section of Gastroenterology, Gastrointestinal Oncology, Hepatology, Infectiology and Geriatrics, University Hospital of Tübingen, 72076 Tübingen, Germany (U.S.); (N.P.M.); (C.R.W.); (D.W.)
| | - Michelle E. Bauer
- Department of Internal Medicine I, Section of Gastroenterology, Gastrointestinal Oncology, Hepatology, Infectiology and Geriatrics, University Hospital of Tübingen, 72076 Tübingen, Germany (U.S.); (N.P.M.); (C.R.W.); (D.W.)
| | - Ulrike Schempf
- Department of Internal Medicine I, Section of Gastroenterology, Gastrointestinal Oncology, Hepatology, Infectiology and Geriatrics, University Hospital of Tübingen, 72076 Tübingen, Germany (U.S.); (N.P.M.); (C.R.W.); (D.W.)
| | - Dietmar Stüker
- Department of Internal Medicine I, Section of Gastroenterology, Gastrointestinal Oncology, Hepatology, Infectiology and Geriatrics, University Hospital of Tübingen, 72076 Tübingen, Germany (U.S.); (N.P.M.); (C.R.W.); (D.W.)
| | - Gunnar Blumenstock
- Department of Clinical Epidemiology, Eberhard-Karls-University, 72076 Tübingen, Germany
| | - Nisar P. Malek
- Department of Internal Medicine I, Section of Gastroenterology, Gastrointestinal Oncology, Hepatology, Infectiology and Geriatrics, University Hospital of Tübingen, 72076 Tübingen, Germany (U.S.); (N.P.M.); (C.R.W.); (D.W.)
| | - Christoph R. Werner
- Department of Internal Medicine I, Section of Gastroenterology, Gastrointestinal Oncology, Hepatology, Infectiology and Geriatrics, University Hospital of Tübingen, 72076 Tübingen, Germany (U.S.); (N.P.M.); (C.R.W.); (D.W.)
| | - Dörte Wichmann
- Department of Internal Medicine I, Section of Gastroenterology, Gastrointestinal Oncology, Hepatology, Infectiology and Geriatrics, University Hospital of Tübingen, 72076 Tübingen, Germany (U.S.); (N.P.M.); (C.R.W.); (D.W.)
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Attard TM, Cohen S, Durno C. Polyps and Polyposis Syndromes in Children: Novel Endoscopic Considerations. Gastrointest Endosc Clin N Am 2023; 33:463-486. [PMID: 36948756 DOI: 10.1016/j.giec.2022.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
Polypectomy is the most common therapeutic endoscopic intervention in children. Management of sporadic juvenile polyps is limited to polypectomy to resolve symptoms, whereas polyposis syndromes pose a multidisciplinary challenge with broader ramifications. In preparation for polypectomy, there are key patient, polyp, endoscopy unit, and provider characteristics that factor into the likelihood of success. Younger age and multiple medical comorbidities increase the risk of adverse outcomes, classified as intraoperative, immediate postoperative, and delayed postoperative complications. Novel techniques, including cold snare polypectomy, can significantly decrease adverse events but a more structured training process for polypectomy in pediatric gastroenterology is needed.
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Affiliation(s)
- Thomas M Attard
- Division of Gastroenterology, Hepatology and Nutrition, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108, USA; The University of Missouri in Kansas City School of Medicine, Kansas City, MO, USA.
| | - Shlomi Cohen
- Pediatric Gastroenterology Institute, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Carol Durno
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; The Zane Cohen Centre for Digestive Diseases, 60 Murray Street, Toronto, Ontario M5T 3L9, Canada; Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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Omori T, Funasaka K, Horiguchi N, Kamano T, Nagasaka M, Nakagawa Y, Miyahara R, Hashimoto S, Shibata T, Ohmiya N, Hirooka Y. Injury to the muscle layer, increasing the risk of post-colorectal endoscopic submucosal dissection electrocoagulation syndrome. J Gastroenterol Hepatol 2023; 38:87-93. [PMID: 36200387 DOI: 10.1111/jgh.16021] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/13/2022] [Accepted: 10/02/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND AIM In colorectal endoscopic submucosal dissection (ESD), post-ESD electrocoagulation syndrome (PECS) has been recognized as one of the major complications. There are no reports on the relationships between ESD findings and PECS. This study aims to evaluate the risk factors for PECS, including ESD findings such as muscularis propria exposure. METHODS We performed a retrospective cohort study of patients who underwent colorectal ESD between January 2017 and December 2021 in Japan. The grade of injury to the muscle layer caused by ESD was categorized as follows: Grade 0, no exposure of muscularis propria; Grade 1, muscularis propria exposure; Grade 2, torn muscularis propria; and Grade 3, colon perforation. The risk factors for PECS, including injury to the muscle layer, were analyzed by univariate and multivariate analyses. RESULTS Out of 314 patients who underwent colorectal ESD, PECS occurred in 28 patients (8.9%). The multivariate analysis showed that female sex (odds ratio [OR] 3.233; 95% confidence interval [95% CI]: 1.264-8.265, P = 0.014), large specimen size (≥ 40 mm) (OR 6.138; 95% CI: 1.317-28.596, P = 0.021), long procedure time (≥ 90 min) (OR 2.664; 95% CI: 1.053-6.742, P = 0.039), and Grade 1 or 2 injury to the muscle layer (OR 3.850; 95% CI: 1.090-13.61, P = 0.036) were independent risk factors for PECS. CONCLUSIONS Injury to the muscle layer, such as exposure or tear, was identified as a novel independent risk factor for PECS. We should perform colorectal ESD carefully to avoid injuring the muscle layers.
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Affiliation(s)
- Takafumi Omori
- Department of Gastroenterology and Hepatology, Fujita Health University, Toyoake, Aichi, Japan
| | - Kohei Funasaka
- Department of Gastroenterology and Hepatology, Fujita Health University, Toyoake, Aichi, Japan
| | - Noriyuki Horiguchi
- Department of Gastroenterology and Hepatology, Fujita Health University, Toyoake, Aichi, Japan
| | - Toshiaki Kamano
- Department of Gastroenterology and Hepatology, Fujita Health University, Toyoake, Aichi, Japan
| | - Mitsuo Nagasaka
- Department of Gastroenterology and Hepatology, Fujita Health University, Toyoake, Aichi, Japan
| | - Yoshihito Nakagawa
- Department of Gastroenterology and Hepatology, Fujita Health University, Toyoake, Aichi, Japan
| | - Ryoji Miyahara
- Department of Gastroenterology and Hepatology, Fujita Health University, Toyoake, Aichi, Japan
| | - Senju Hashimoto
- Department of Gastroenterology and Hepatology, Fujita Health University, Toyoake, Aichi, Japan
| | - Tomoyuki Shibata
- Department of Gastroenterology and Hepatology, Fujita Health University, Toyoake, Aichi, Japan
| | - Naoki Ohmiya
- Department of Advanced Endoscopy, Fujita Health University, Toyoake, Aichi, Japan
| | - Yoshiki Hirooka
- Department of Gastroenterology and Hepatology, Fujita Health University, Toyoake, Aichi, Japan
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Qiu J, Ouyang Q, Zhang Y, Xu J, Xie Y, Wei W, Pan X. Post-endoscopic submucosal dissection electrocoagulation syndrome: a clinical overview. Expert Rev Gastroenterol Hepatol 2022; 16:1079-1087. [PMID: 36503328 DOI: 10.1080/17474124.2022.2156858] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Post-endoscopic submucosal dissection electrocoagulation syndrome (PEECS) is a rare complication following endoscopic submucosal dissection (ESD). However, many aspects of PEECS are still controversial and there is a lack of up-to-date review. The aim of this article is to provide a comprehensive review on PEECS. AREAS COVERED The English-language literature was searched for articles on PEECS, with a focus on its pathogenesis, definition, and diagnosis, incidence rate, risk factors, prevention, management, and prognosis. EXPERT OPINION Many aspects of PEECS are still controversial such as etiology, diagnostic criteria, prevention and management. The recent studies tend to agree on the diagnostic criteria for PEECS, defined as localized abdominal tenderness and fever or inflammatory response without delayed perforation. Most patients with PEECS have a favorable prognosis with conservative treatment and more high-quality studies are needed in the controversial aspects mentioned above.
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Affiliation(s)
- Jiayu Qiu
- Digestive Disease Hospital, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.,Department of Gastroenterology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Qingping Ouyang
- Digestive Disease Hospital, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.,Department of Gastroenterology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yanxia Zhang
- Digestive Disease Hospital, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.,Department of Gastroenterology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jun Xu
- Digestive Disease Hospital, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.,Department of Gastroenterology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yingping Xie
- Digestive Disease Hospital, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.,Department of Gastroenterology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Wenjun Wei
- Digestive Disease Hospital, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.,Department of Gastroenterology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xiaolin Pan
- Digestive Disease Hospital, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.,Department of Gastroenterology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
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Adverse Events Associated with Routine Colonoscopy in Patients with End-Stage Renal Disease. Dig Dis Sci 2022; 67:3158-3165. [PMID: 34383200 DOI: 10.1007/s10620-021-07137-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/24/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM Although colonoscopy has been widely performed in patients with end-stage renal disease (ESRD), studies on the safety of routine colonoscopy, including bowel preparation and sedation, in these patients are limited. This study aimed to investigate the safety of colonoscopy in patients with ESRD who underwent peritoneal dialysis (PD) or hemodialysis (HD). METHODS We retrospectively reviewed 538 patients with ESRD who underwent colonoscopy between 2010 and 2020. We compared the incidence of adverse events (AEs) between the ESRD group and a propensity score-matched control group of healthy adults. Cardiovascular/pulmonary and procedure-related AEs were analyzed. We also compared the rates of AEs between patients who underwent PD or HD. RESULTS The overall rate of AEs was 5.7% in patients with ESRD, which was significantly higher than that in healthy adults (0.6%, P < 0.001). All AEs were cardiovascular/pulmonary in nature, but no perforation or bleeding occurred. Most AEs were not severe and resolved with medical treatment. The incidence of AEs was higher in the HD group than in the PD group, but the difference was not significant (6.1% vs. 3.5%, respectively, P = 0.451). In the HD group, patients with AEs were significantly older than those without AEs (P = 0.009). CONCLUSIONS The rate of colonoscopy-related AEs in patients with ESRD on dialysis was higher than that in healthy adults, but most AEs were not severe. Routine colonoscopy may be safely performed in patients with ESRD regardless of the method of dialysis, but more carefully in older patients on HD.
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Keraliya A, Yu HS, Uyeda JW. CT imaging findings of complications of optical colonoscopy. Emerg Radiol 2022; 29:915-923. [PMID: 35710648 DOI: 10.1007/s10140-022-02058-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 05/06/2022] [Indexed: 10/18/2022]
Abstract
Colonoscopy is one of the most commonly performed endoscopic procedures and remains the most commonly used screening modality method for colorectal cancer (CRC) screening in the USA. Although serious complications of fiberoptic colonoscopy are uncommon due to technical advances, due to increasing number of colonoscopy procedures, post-procedural complications are not uncommonly encountered in the routine clinical practice. Also, as some of the post-colonoscopy complications are life threatening, it is important to diagnose them early so that timely treatment measures can be taken to decrease mortality and morbidity. In this review, we present a case-based illustration of the utility of CT to detect complications of colonoscopy including bowel perforation, hemorrhage, splenic injury, and postpolypectomy syndrome.
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Affiliation(s)
- Abhishek Keraliya
- Department of Radiology, Emergency Radiology Division, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA
| | - Hei Shun Yu
- Department of Radiology, Emergency Radiology Division, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA
| | - Jennifer W Uyeda
- Department of Radiology, Emergency Radiology Division, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA.
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10
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Clinical characteristics and outcome of iatrogenic colonic perforation related to diagnostic vs. therapeutic colonoscopy. Surg Endosc 2022; 36:5938-5946. [PMID: 35048189 PMCID: PMC9283341 DOI: 10.1007/s00464-022-09010-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 01/03/2022] [Indexed: 12/19/2022]
Abstract
Aim Iatrogenic colonic perforation (ICP) is a rare serious complication of colonoscopy, where standard treatment is controversial. This study aimed to characterize diagnostic ICP (DICP) compared to therapeutic ICP (TICP) and determine the possible indication of endoscopic repair. Methods We studied patients with ICP over 7 years starting in 2011. Their demographics and data regarding perforation, treatment, and outcome were investigated by retrospective review of medical records, and the diagnostic and therapeutic groups were compared. Results Among 29,882 patients who underwent colonoscopy, ICP was identified in 28 (0.09%: diagnostic, 15/24,758, 0.06%; therapeutic, 13/5124, 0.25%). A total of 56 patients (33 DICP and 23 TICP) including 28 referred cases were analyzed. Mean age was 62.3 ± 11.4 years, and 24 were men. Perforations occurred mostly in the rectosigmoid region and half were detected during or immediately after colonoscopy. Endoscopic treatment was successful in 22 cases and 34 required surgery. Mortality occurred in 4 (7.1%). Compared to TICP, DICP was more prevalent in females and rectosigmoid region and more frequently detected immediately (all p < 0.05); DICP tended to occur in older patients, be larger and have better chance of endoscopic repair. Regardless of type of ICP, female predominance, smaller perforation, more frequent immediate detection, and shorter hospital stay (all p = 0.01) were found in the endoscopic repair group. Conclusion DICP was more frequent in the rectosigmoid area in older women and could be detected immediately. Immediate detection and small perforation size could be important factors for endoscopic repair. Careful attention and gentle manipulation should be required.
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de Benito Sanz M, Hernández L, Garcia Martinez MI, Diez-Redondo P, Joao Matias D, Gonzalez-Santiago JM, Ibáñez M, Núñez Rodríguez MH, Cimavilla M, Tafur C, Mata L, Guardiola-Arévalo A, Feito J, García-Alonso FJ. Efficacy and safety of cold versus hot snare polypectomy for small (5-9 mm) colorectal polyps: a multicenter randomized controlled trial. Endoscopy 2022; 54:35-44. [PMID: 33264811 DOI: 10.1055/a-1327-8357] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Resection techniques for small polyps include cold snare polypectomy (CSP) and hot snare polypectomy (HSP). This study compared CSP and HSP in 5-9 mm polyps in terms of complete resection and adverse events. METHODS This was a multicenter, randomized trial conducted in seven Spanish centers between February and November 2019. Patients with ≥ 1 5-9 mm polyp were randomized to CSP or HSP, regardless of morphology or pit pattern. After polypectomy, two marginal biopsies were submitted to a pathologist who was blinded to polyp histology. Complete resection was defined as normal mucosa or burn artifacts in the biopsies. Abdominal pain was only assessed in patients without < 5 mm or > 9 mm polyps. RESULTS 496 patients were randomized: 237 (394 polyps) to CSP and 259 (397 polyps) to HSP. Complete polypectomy rates were 92.5 % with CSP and 94.0 % with HSP (difference 1.5 %, 95 % confidence interval -1.9 % to 4.9 %). Intraprocedural bleeding occurred during three CSPs (0.8 %) and seven HSPs (1.8 %) (P = 0.34). One lesion per group (0.4 %) presented delayed hemorrhage. Post-colonoscopy abdominal pain presented similarly in both groups 1 hour after the procedure (CSP 18.8 % vs. HSP 18.4 %) but was higher in the HSP group after 5 hours (5.9 % vs. 16.5 %; P = 0.02). A higher proportion of patients were asymptomatic 24 hours after CSP than after HSP (97 % vs. 86.4 %; P = 0.01). CONCLUSIONS We observed no differences in complete resection and bleeding rates between CSP and HSP. CSP reduced the intensity and duration of post-colonoscopy abdominal pain.
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Affiliation(s)
- Marina de Benito Sanz
- Department of Gastroenterology, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Luis Hernández
- Department of Gastroenterology, Hospital Santos Reyes, Aranda de Duero, Burgos, Spain
| | | | - Pilar Diez-Redondo
- Department of Gastroenterology, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Diana Joao Matias
- Department of Gastroenterology, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | | | - Mercedes Ibáñez
- Department of Gastroenterology, Hospital de Medina del Campo, Valladolid, Spain
| | | | - Marta Cimavilla
- Department of Gastroenterology, Hospital Río Carrión, Palencia, Spain
| | - Carla Tafur
- Department of Gastroenterology, Hospital de Medina del Campo, Valladolid, Spain
| | - Laura Mata
- Department of Gastroenterology, Hospital de Medina del Campo, Valladolid, Spain
| | - Antonio Guardiola-Arévalo
- Department of Gastroenterology, Hospital Universitario de Fuenlabrada, IdiPAz (Instituto de investigación Hospital Universitario La Paz), Madrid, Spain
| | - Jorge Feito
- Department of Pathology, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
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12
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Ochi M, Kawagoe R, Kamoshida T, Hamano Y, Ohkawara H, Ohkawara A, Kakinoki N, Yamaguchi Y, Hirai S, Yanaka A, Tsuchiya K. High total Joule heat increases the risk of post-endoscopic submucosal dissection electrocoagulation syndrome after colorectal endoscopic submucosal dissection. World J Gastroenterol 2021; 27:6442-6452. [PMID: 34720533 PMCID: PMC8517781 DOI: 10.3748/wjg.v27.i38.6442] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/17/2021] [Accepted: 09/10/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND We hypothesized that thermal damage accumulation during endoscopic submucosal dissection (ESD) causes the pathogenesis of post-ESD electrocoagulation syndrome (PECS).
AIM To determine the association between Joule heat and the onset of PECS.
METHODS We performed a retrospective cohort study in patients who underwent colorectal ESD from May 2013 to March 2021 in Japan. We developed a novel device that measures swift coagulation time with a sensor adjacent to the electrosurgical coagulation unit foot switch, which enabled us to calculate total Joule heat. PECS was defined as localized abdominal pain (visual analogue scale ≥ 30 mm during hospitalization or increased by ≥ 20 mm from the baseline) and fever (temperature ≥ 37.5 degrees or white blood cell count ≥ 10000 µ/L). Patients exposed to more or less than the median Joule heat value were assigned to the high and low Joule heat groups, respectively. Statistical analyses included Mann-Whitney U and chi-square tests and logistic regression and receiver operating characteristic curve (ROC) analyses.
RESULTS We evaluated 151 patients. The PECS incidence was 10.6% (16/151 cases), and all patients were followed conservatively and discharged without severe complications. In multivariate analysis, high Joule heat was an independent PECS risk factor. The area under the ROC curve showing the correlation between PECS and total Joule heat was high [0.788 (95% confidence interval: 0.666-0.909)].
CONCLUSION Joule heat accumulation in the gastrointestinal wall is involved in the onset of PECS. ESD-related thermal damage to the peeled mucosal surface is probably a major component of the mechanism underlying PECS.
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Affiliation(s)
- Masanori Ochi
- Department of Gastroenterology, Hitachi General Hospital, Hitachi City 317-0077, Ibaraki, Japan
| | - Ryosuke Kawagoe
- Department of Gastroenterology, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8576, Ibaraki, Japan
| | - Toshiro Kamoshida
- Department of Gastroenterology, Hitachi General Hospital, Hitachi City 317-0077, Ibaraki, Japan
| | - Yukako Hamano
- Department of Gastroenterology, Hitachi General Hospital, Hitachi City 317-0077, Ibaraki, Japan
| | - Haruka Ohkawara
- Department of Gastroenterology, Hitachi General Hospital, Hitachi City 317-0077, Ibaraki, Japan
| | - Atsushi Ohkawara
- Department of Gastroenterology, Hitachi General Hospital, Hitachi City 317-0077, Ibaraki, Japan
| | - Nobushige Kakinoki
- Department of Gastroenterology, Hitachi General Hospital, Hitachi City 317-0077, Ibaraki, Japan
| | - Yuji Yamaguchi
- Department of Gastroenterology, Hitachi General Hospital, Hitachi City 317-0077, Ibaraki, Japan
| | - Shinji Hirai
- Department of Gastroenterology, Hitachi General Hospital, Hitachi City 317-0077, Ibaraki, Japan
| | - Akinori Yanaka
- Department of Gastroenterology, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8576, Ibaraki, Japan
| | - Kiichiro Tsuchiya
- Department of Gastroenterology, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8576, Ibaraki, Japan
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13
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Medico-legal implications for the colon perforation during colonoscopy. J Forensic Leg Med 2021; 80:102185. [PMID: 34000660 DOI: 10.1016/j.jflm.2021.102185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 05/07/2021] [Accepted: 05/09/2021] [Indexed: 11/21/2022]
Abstract
Colon perforation is the most serious complication of colonoscopy, and tends to be considered as malpractice. The aim of this study was to identify the characteristics and causes of medical accidents by analyzing lawsuit cases on colon perforation during colonoscopy. We collected judgment results that were ruled from 2005 to 2015 using the keyword 'colonoscopy' in the 'Korea's Written Judgment Public Reading System' of the Supreme Court, and extracted the cases of colon perforation. Characteristics of medical accidents and the decisions of courts were analyzed from written judgments. Twenty-two lawsuits were analyzed. Most cases were ruled in favor of the plaintiff (n = 20). The allegations against defendants, as filed by the plaintiffs, were performance error (n = 22), improper monitoring after colonoscopy (n = 7), and a lack of informed consent (n = 8). The median compensation was 9335.47 US dollars; this is about 130 times the cost of a single colonoscopy in Korea. The greater the intestinal damage, the greater the amount of compensation (p = 0.016). The time interval from procedure to diagnosis of perforation was most frequently 24 h later (n = 9). It is important to educate patients completely about the symptoms of colon perforation and to guide them to contact medical institutions immediately when symptoms occur. In addition, doctors should explain sufficiently the possibility of perforation before colonoscopy to the patient, and not the caregiver, and get informed consent.
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14
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Arimoto J, Chiba H, Ashikari K, Fukui R, Tachikawa J, Suto T, Kawano N, Niikura T, Kuwabara H, Nakaoka M, Ida T, Higurashi T, Goto T, Nakajima A. Safety and efficacy of cold snare polypectomy for pedunculated (Ip) polyps measuring less than 10 mm in diameter. Int J Colorectal Dis 2020; 35:859-867. [PMID: 32112197 DOI: 10.1007/s00384-020-03547-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/18/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although cold snare polypectomy (CSP) has spread rapidly, it still remains controversial whether CSP is safe for pedunculated (Ip) polyps. PURPOSE The aim of this study was to evaluate whether CSP for Ip polyps measuring less than 10 mm in diameter might be associated with an increased rate of delayed post-polypectomy bleeding (DPPB). METHODS A total of 1641 colorectal polyps in 634 patients were resected at Omori Red Cross Hospital between April 2018 and December 2018. The polyps were divided into two groups depending on the morphology: the Ip group (90 polyps), and the non-Ip group (1551 polyps). RESULTS Among the 1641 polyps, there was no case of DPPB, including in the Ip group. Immediate bleeding occurred in a total of 101 (6.2%) cases. Polyp location in the rectum (OR (95% CI), 3.61 (1.843-7.092); p < 0.001), polyp diameter ≥ 6 mm (OR (95% CI), 2.65 (1.702-4.132); p < 0.001), Ip morphology (OR (95% CI), 15.66 (9.262-26.49); p < 0.001), and treatment with antithrombotic agents (OR (95% CI), 2.18 (1.358-3.501); p = 0.0012) were identified as significant risk factors for immediate bleeding. CONCLUSIONS This is the first study conducted to examine the safety of CSP for Ip polyps measuring less than 10 mm in diameter. CSP can be performed with a high level of safety even for Ip polyps. Based on our findings, we believe that Ip polyps could be included as an indication for CSP. However, prospective, randomized studies are necessary to confirm our results.
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Affiliation(s)
- Jun Arimoto
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Hideyuki Chiba
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan.
| | - Keiichi Ashikari
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Ryo Fukui
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Jun Tachikawa
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Takuma Suto
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Naoya Kawano
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Toshihiro Niikura
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Hiroki Kuwabara
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Michiko Nakaoka
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Tomonori Ida
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Takuma Higurashi
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Tohru Goto
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Atsushi Nakajima
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
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Matz D, Heizmann O. Necrotizing Fasciitis of The Abdominal Wall Following Colonoscopy with Fatal Outcome - A Case Report. Surg Case Rep 2019. [DOI: 10.31487/j.scr.2019.05.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Necrotizing fasciitis (NF) is a serious and potentially life threatening soft tissue infection, usually caused by different types of bacteria such as group A streptococcus, staphylococcus spp. (type 1 infection) or mixed infection by aerobic and anaerobic bacteria (type 2 infection). Usually, the infection arises from skin injury, in injections or surgical procedures and effects the fascia as well as the subcutaneous tissue. Overwhelming progression and difficulties in diagnosing are very common. Mortality rate is up to 100% depending on the type of soft tissue infection and did not markedly decrease in the past decades [1]. Here we present a case of NF with fatal outcome following colonoscopy, which was primarily suspected to be a post polypectomy syndrome.
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16
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Wickham C, Mirza KL, Lee SW. Management of colonoscopic perforation. SEMINARS IN COLON AND RECTAL SURGERY 2019. [DOI: 10.1016/j.scrs.2019.100686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Approach to iatrogenic colon perforations due to colonoscopy: A retrospective cohort study. JOURNAL OF SURGERY AND MEDICINE 2019. [DOI: 10.28982/josam.537902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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18
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Chew CR, Yeung JMC, Faragher IG. Treatment of colonoscopic perforation: outcomes from a major single tertiary institution. ANZ J Surg 2019; 89:546-551. [PMID: 30896081 DOI: 10.1111/ans.15068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 11/02/2018] [Accepted: 12/09/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND The use of colonoscopy has been increasing in Australia. This case series describes management and outcomes of colonoscopic perforation managed by a single tertiary referral unit. METHODS An analysis of 13 years (2003-2015) of prospectively collected data on patients who had a colonoscopic perforation and were managed by the colorectal unit at a single tertiary referral centre was performed. Main outcomes were time of diagnosis, modality of management, time to theatre, length of stay, cost of admission and complications. RESULTS Sixty-two patients had perforations (median age of 69 years). Thirty-eight (61.2%) patients had their colonoscopy performed in another institution. The incidence rate decreased to 0.37 perforations per 1000 colonoscopies within Western Health. Overall, diagnostic colonoscopies accounted for 56% of perforations and perforations were likely to occur in the left colon (P = 0.006). Fifty-one (82%) patients underwent surgery during their admission, with 24% of these being laparoscopic procedures. An earlier diagnosis was associated with significantly less intra-abdominal contamination. Gross peritoneal contamination was more likely to be associated with the decision to form a stoma (37%, n = 19, P = 0.04). Thirty-day mortality was 1.6% (n = 1). CONCLUSIONS Colonoscopic perforations occur in experienced hands and may have serious implications. We demonstrated a difference in patterns of injury between therapeutic and diagnostic colonoscopies. Those who have an earlier diagnosis are less likely to have severe intra-abdominal contamination requiring a stoma formation.
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Affiliation(s)
- Carolyn R Chew
- Department of Colorectal Surgery, Footscray Hospital, Western Health, Melbourne, Victoria, Australia
| | - Justin M C Yeung
- Department of Colorectal Surgery, Footscray Hospital, Western Health, Melbourne, Victoria, Australia.,Department of Surgery, Sunshine Hospital, Western Health, Melbourne, Victoria, Australia
| | - Ian G Faragher
- Department of Colorectal Surgery, Footscray Hospital, Western Health, Melbourne, Victoria, Australia.,Department of Surgery, Sunshine Hospital, Western Health, Melbourne, Victoria, Australia
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19
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“Underwater” endoscopic submucosal dissection: a novel method for resection in saline with a bipolar needle knife for colorectal epithelial neoplasia. Surg Endosc 2018; 32:5031-5036. [DOI: 10.1007/s00464-018-6278-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 06/18/2018] [Indexed: 12/20/2022]
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20
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Yamasaki Y, Takeuchi Y, Iwatsubo T, Kato M, Hamada K, Tonai Y, Matsuura N, Kanesaka T, Yamashina T, Arao M, Suzuki S, Shichijo S, Nakahira H, Akasaka T, Hanaoka N, Higashino K, Uedo N, Ishihara R, Okada H, Iishi H. Line-assisted complete closure for a large mucosal defect after colorectal endoscopic submucosal dissection decreased post-electrocoagulation syndrome. Dig Endosc 2018; 30:633-641. [PMID: 29573468 DOI: 10.1111/den.13052] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 03/09/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIM The incidence of post-endoscopic submucosal dissection (ESD) coagulation syndrome (PECS) can be decreased by closing mucosal defects. However, large mucosal defects after colorectal ESD cannot be closed endoscopically. We established line-assisted complete clip closure (LACC), a novel technique for large mucosal defects after colorectal ESD. We evaluated the prophylactic efficacy of LACC for preventing PECS. METHODS Sixty-one consecutive patients on whom LACC after colorectal ESD was attempted from January 2016 to August 2016 were analyzed. After exclusion of patients with incomplete LACC and adverse events during ESD, 57 patients comprised the LACC group. In contrast, 495 patients who did not undergo closure of a mucosal defect comprised the control group. Propensity score matching was used to adjust for patients' backgrounds. Treatment outcomes were evaluated between the groups. RESULTS Median resected specimen size in the LACC-attempted group was 35 mm (range, 20-72 mm), and LACC success rate was 95% (58/61). Median procedure time of LACC was 14 min. In the LACC group, incidence of PECS was only 2%, and no delayed bleeding or perforation occurred. Propensity score matching created 51 matched pairs. Adjusted comparisons between the LACC and control groups showed a lower incidence of PECS (0% vs 12%, respectively; P = 0.03) and shorter hospitalization (5 vs 6 days, respectively; P < 0.001) in the LACC group. CONCLUSION This study suggests that LACC can effectively reduce the incidence of PECS, although further large-scale studies are warranted.
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Affiliation(s)
- Yasushi Yamasaki
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
- Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
| | - Yoji Takeuchi
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Taro Iwatsubo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Minoru Kato
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Kenta Hamada
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
- Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
| | - Yusuke Tonai
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Noriko Matsuura
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Takashi Kanesaka
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Takeshi Yamashina
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
- Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka, Japan
| | - Masamichi Arao
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Sho Suzuki
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Satoki Shichijo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroko Nakahira
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Tomofumi Akasaka
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Noboru Hanaoka
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
- Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka, Japan
| | - Koji Higashino
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Noriya Uedo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Ryu Ishihara
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroyuki Okada
- Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
| | - Hiroyasu Iishi
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
- Department of Gastroenterology, Itami City Hospital, Itami, Japan
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21
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Kobayashi R, Hirasawa K, Sato C, Makazu M, Kaneko H, Ikeda R, Fukuchi T, Sawada A, Ozeki Y, Taguri M, Takebayashi S, Maeda S. Utility of multi-detector computed tomography scans after colorectal endoscopic submucosal dissection: a prospective study. Gastrointest Endosc 2018; 87:818-826. [PMID: 29122602 DOI: 10.1016/j.gie.2017.10.038] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 10/23/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Several reports have described major adverse events after endoscopic submucosal dissection (ESD), such as perforation or bleeding. However, few studies have discussed the occurrence of post-ESD electrocoagulation syndrome (PEECS) after colorectal ESD. In addition, the occurrence of fever without abdominal pain in patients requires postoperative management similar to that required for PEECS. Therefore, we have defined post-ESD inflammatory syndrome (PEIS) composed of both PEECS and fever without abdominal pain. This study aimed to evaluate the correlation between the findings of multi-detector computed tomography (MDCT) imaging and PEIS in patients. METHODS Between January 2015 and October 2015, we performed colorectal ESD in 100 patients; after this, all patients underwent abdominal examinations by MDCT scans. Nine patients who experienced intraoperative perforations or penetrations were excluded; 91 patients were enrolled in our prospective study. MDCT findings in patients were classified according to the amount of extraluminal gas. The patients were divided into 2 groups based on the presence or absence of extraluminal gas and were assessed for co-occurring PEIS. RESULTS Among the 91 patients, extraluminal gas was observed in 31 (34%); of these, PEIS occurred in 14 (15%) patients. Patients with extraluminal gas had increased incidence of PEIS compared with patients without extraluminal gas (29% vs 8%, P = .014). CONCLUSIONS Extraluminal gas was detected by MDCT in many cases and significantly correlated with the occurrence of PEIS, even in cases without obvious intraoperative perforation or penetration. MDCT findings after ESD may be useful for predicting PEIS and appropriate perioperative management.
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Affiliation(s)
- Ryosuke Kobayashi
- Division of Endoscopy, Yokohama City University Medical Center, Minami-ku, Yokohama, Japan
| | - Kingo Hirasawa
- Division of Endoscopy, Yokohama City University Medical Center, Minami-ku, Yokohama, Japan
| | - Chiko Sato
- Division of Endoscopy, Yokohama City University Medical Center, Minami-ku, Yokohama, Japan
| | - Makomo Makazu
- Division of Endoscopy, Yokohama City University Medical Center, Minami-ku, Yokohama, Japan
| | - Hiroaki Kaneko
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Kanazawa-ku, Yokohama, Japan
| | - Ryosuke Ikeda
- Division of Endoscopy, Yokohama City University Medical Center, Minami-ku, Yokohama, Japan
| | - Takehide Fukuchi
- Division of Endoscopy, Yokohama City University Medical Center, Minami-ku, Yokohama, Japan
| | - Atsushi Sawada
- Division of Endoscopy, Yokohama City University Medical Center, Minami-ku, Yokohama, Japan
| | - Yuichiro Ozeki
- Division of Endoscopy, Yokohama City University Medical Center, Minami-ku, Yokohama, Japan
| | - Masataka Taguri
- Department of Biostatistics, Yokohama City University School of Medicine, Kanazawa-ku, Yokohama, Japan
| | - Shigeo Takebayashi
- Department of Diagnostic Radiology, Yokohama City University Medical Center, Minami-ku, Yokohama, Japan
| | - Shin Maeda
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Kanazawa-ku, Yokohama, Japan
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Arimoto J, Higurashi T, Kato S, Fuyuki A, Ohkubo H, Nonaka T, Yamaguchi Y, Ashikari K, Chiba H, Goto S, Taguri M, Sakaguchi T, Atsukawa K, Nakajima A. Risk factors for post-colorectal endoscopic submucosal dissection (ESD) coagulation syndrome: a multicenter, prospective, observational study. Endosc Int Open 2018; 6. [PMID: 29527556 PMCID: PMC5842075 DOI: 10.1055/s-0044-101451] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Colorectal cancer (CRC) is one of the most common neoplasms and endoscopic submucosal dissection (ESD) is an effective treatment for early-stage CRC. However, it has been observed that patients undergoing ESD often complain of pain, even if ESD has been successfully performed. Risk factors for such pain still remain unknown. The aim of this study was to explore the risk factors for post-colorectal ESD coagulation syndrome (PECS). PATIENTS AND METHODS This was a prospective multicenter observational trial (UMIN000016781) conducted in 106 of 223 patients who underwent ESD between March 2015 and April 2016. We investigated age, sex, tumor location, ESD operation time, lesion size, duration of hospitalization, and frequency of PECS. We defined PECS as local abdominal pain (evaluated on a visual analogue scale) in the region corresponding to the site of the ESD that occurred within 4 days of the procedure. RESULTS PECS occurred in 15/106 (14.2 %), and 10 were women ( P = 0.01, OR: 7.74 [1.6 - 36.4]), 7 had lesions in the cecum ( P < 0.001, OR: 20.6 [3.7 - 115.2]), and 9 in whom ESD operation time was > 90 min ( P = 0.002, OR: 10.3 [2.4 - 44.6]). Frequency of deviation from the prescribed clinical path was significantly higher (47 % [7/15] vs. 2 % [2/91], P < 0.001, OR: 38.9 [6.9 - 219.6]), and hospital stay was significantly longer in the PECS group. . CONCLUSIONS Female gender, location of lesion in the cecum, and ESD operation time > 90 minutes were significant risk factors independent of PECS. These findings are important to management of PECS. .
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Affiliation(s)
- Jun Arimoto
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Takuma Higurashi
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Shingo Kato
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Akiko Fuyuki
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Hidenori Ohkubo
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Takashi Nonaka
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Yoshikazu Yamaguchi
- Department of Anesthesiology and Critical Care, Yokohama City University School of Medicine, Yokohama, Japan
| | - Keiichi Ashikari
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Hideyuki Chiba
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Shungo Goto
- Department of Gastroenterology, Hiratsuka City Hospital, Hiratsuka, Japan
| | - Masataka Taguri
- Department of Biostatistics, Yokohama City University School of Medicine, Yokohama, Japan
| | - Takashi Sakaguchi
- Department of Gastroenterology, Hiratsuka City Hospital, Hiratsuka, Japan
| | - Kazuhiro Atsukawa
- Department of Gastroenterology, Hiratsuka City Hospital, Hiratsuka, Japan
| | - Atsushi Nakajima
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan,Corresponding author Atsushi Nakajima 3-9 Fukuura, Kanazawa-kuYokohama 236-0004Japan+81-45-784-3546
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Abstract
Purpose The management of a colonoscopic perforation (CP) varies from conservative to surgical. The objective of this study was to evaluate the outcomes between surgical and conservative treatment of patients with a CP. Methods From 2003 to 2016, the medical records of patients with CP were retrospectively reviewed. Patients were divided into 2 groups depending on whether they initially received conservative or surgical treatment. Results During the study period, a total of 48 patients with a CP were treated. Among them, 5 patients had underlying colorectal cancer and underwent emergency radical cancer surgery; these patients were excluded. The mean age of the remaining 43 patients was 64.5 years old, and the most common perforation site was the sigmoid colon (15 patients). The initial conservative care group included 16 patients, and the surgery group included 27 patients. In the conservative group, 5 patients required conversion to surgery (failure rate: 5 of 16 [31.3%]). Of the surgery group, laparoscopic surgery was performed on 19 patients and open surgery on 8 patients, including 2 conversion cases. Major postoperative complications developed in 11 patients (34.4%), and postoperative mortality developed in 4 patients (12.5%). The only predictor for poor prognosis after surgery was a high American Society of Anesthesiologists physical status classification. Conclusion In this study, conservative treatment for patients with a CP had a relatively high failure rate. Furthermore, surgical treatment showed significant rates of complications and mortality, which depended on the general status of the patients.
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Affiliation(s)
- Jae Ho Park
- Department of Surgery, Chosun University School of Medicine, Gwangju, Korea
| | - Kyung Jong Kim
- Department of Surgery, Chosun University School of Medicine, Gwangju, Korea
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Lowenfeld L, Saur NM, Bleier JI. How to avoid and treat endoscopic complications. SEMINARS IN COLON AND RECTAL SURGERY 2017. [DOI: 10.1053/j.scrs.2016.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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25
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Choi PW. Pneumomediastinum, Pneumothorax, and Subcutaneous Emphysema Caused by Colonoscopic Perforation: A Report of Two Cases. J Emerg Med 2016; 52:e117-e122. [PMID: 27876330 DOI: 10.1016/j.jemermed.2016.10.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 10/21/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND Although colonoscopy is generally a safe procedure, lethal complications can occur. Colonoscopic perforation is one of the most serious complications, and it can present with various clinical symptoms and signs. Aggravating abdominal pain and free air on simple radiography are representative clinical manifestations of colonoscopic perforation. However, unusual symptoms and signs, such as dyspnea and subcutaneous emphysema, which are less likely to be related with complicating colonoscopy, may obscure correct clinical diagnosis. We present two cases of pneumomediastinum, pneumothorax, and subcutaneous emphysema caused by colonoscopic perforation. CASE REPORT A 75-year-old woman and a 65-year-old man presented with dyspnea, and facial swelling and abdominal pain, respectively. In the first case, symptoms occurred during polypectomy, whereas they occurred after polypectomy in the second case. Chest radiograph and computed tomography scans revealed pneumomediastinum, pneumothorax, and subcutaneous emphysema in the neck. During both operations, an ascending colonic subserosa filled with air bubbles was observed, and laparoscopic right hemicolectomy was performed in the first case. In the second case, after mobilization of the right colon, retroperitoneal colonic perforation was identified and primary repair was performed. The postoperative course was uneventful. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: These cases show the unusual clinical manifestations of colonoscopic perforation, which depend on the mechanism of perforation. Awareness of these less typical manifestations is crucial for prompt diagnosis and management for an emergency physician.
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Affiliation(s)
- Pyong Wha Choi
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
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Shin Y, Kim Y, Lee K, Lee Y, Park J. CT findings of post-polypectomy coagulation syndrome and colonic perforation in patients who underwent colonoscopic polypectomy. Clin Radiol 2016; 71:1030-1036. [DOI: 10.1016/j.crad.2016.03.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 01/29/2016] [Accepted: 03/15/2016] [Indexed: 12/27/2022]
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Kim HJ, Chung H, Jung DH, Park JC, Shin SK, Lee SK, Lee YC. Clinical outcomes of and management strategy for perforations associated with endoscopic submucosal dissection of an upper gastrointestinal epithelial neoplasm. Surg Endosc 2016; 30:5059-5067. [PMID: 26983439 DOI: 10.1007/s00464-016-4854-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 03/02/2016] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Perforation is one of the major complications of endoscopic submucosal dissection (ESD). In the present study, we investigated the clinical outcomes of and management strategies for ESD-related perforations. METHODS Between February 2010 and April 2014, a total of 3821 patients who underwent ESD for an upper gastrointestinal epithelial neoplasm were analyzed using the Yonsei University Severance Hospital database. Clinical outcomes of and management strategies for perforations in 90 patients (2.4 %) were analyzed. The risk factors for the development of perforation were also investigated. RESULTS The mean age of our subjects was 64.7 ± 12.2 years (male to female ratio, 3.2:1), and the mean size of the resected specimens was 39.4 ± 12.5 mm. Endoscopically visible perforations (visible perforation group) were noted in 74 of the 90 patients (82.2 %), and clinically suspected perforations (suspected perforation group) were noted in 16 patients (17.8 %). Immediate closure with endoclips was attempted in cases with a visible perforation and was successful in 72 (97.3 %) cases. Two patients in whom endoscopic closure failed underwent surgery. Conservative care, including fasting and intravenous antibiotic administration, was attempted in the suspected perforation group, and all the patients were treated successfully without surgery. The mean durations of fasting, antibiotic treatment, and hospital stay were 3.8 ± 3.1, 6.8 ± 4.2, and 8.7 ± 5.3 days, respectively. Subgroup analysis of perforation type (visible perforation vs. suspected perforation) revealed no significant difference in the clinical course. Tumor location at the upper or middle third of the stomach was significantly associated with perforation. CONCLUSION Most of the ESD-related perforations in upper gastrointestinal epithelial neoplasm could be managed successfully in a non-surgical manner under strict monitoring.
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Affiliation(s)
- Hyun Ju Kim
- Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea.,Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.,Yonsei University Graduate School of Medicine, Seoul, Korea
| | - Hyunsoo Chung
- Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea. .,Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea. .,Yonsei University Graduate School of Medicine, Seoul, Korea.
| | - Da Hyun Jung
- Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea.,Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Jun Chul Park
- Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea.,Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Kwan Shin
- Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea.,Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Kil Lee
- Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea.,Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Chan Lee
- Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea.,Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
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Yamashina T, Takeuchi Y, Uedo N, Hamada K, Aoi K, Yamasaki Y, Matsuura N, Kanesaka T, Akasaka T, Yamamoto S, Hanaoka N, Higashino K, Ishihara R, Iishi H. Features of electrocoagulation syndrome after endoscopic submucosal dissection for colorectal neoplasm. J Gastroenterol Hepatol 2016. [PMID: 26202127 DOI: 10.1111/jgh.13052] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Endoscopic submucosal dissection (ESD) is a promising treatment for large gastrointestinal superficial neoplasms, although it is technically difficult, and perforation and delayed bleeding are well-known adverse events. However, there have been no large studies about electrocoagulation syndrome after colorectal ESD. The aim of this study was to evaluate the incidence and clinical significant risk factors of post-ESD coagulation syndrome (PECS). METHODS This was a retrospective cohort study conducted in a referral cancer center. A total of 336 patients with colorectal neoplasms (143 adenomas or serrated lesions and 193 carcinomas) underwent ESD from January 2011 to June 2013. Incidence, outcome, and factors associated with occurrence of PECS were investigated. RESULTS Occurred in 32 patients (9.5%). The median time until PECS was 15.5 h, and the median period of PECS was 32.5 h. Fever (≥37.6 °C) after ESD was found in 41% of the PECS group and 9% of the non-PECS group (P < 0.001). All PECS cases were managed conservatively. On multivariate analysis, female patients (odds ratio [OR] = 3.2, P = 0.002), lesion location at ascending colon and cecum (OR = 3.5, P = 0.001), and resected specimen ≥40 mm (OR = 2.1, P = 0.05) were independent risk factors for PECS. CONCLUSIONS Occurred in 32 patients (9.5%) with colorectal ESD; however, all cases had a good outcome with conservative management. Female sex, tumor location at the ascending colon and cecum, and resected specimen ≥40 mm were independently significant risk factors for PECS.
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Affiliation(s)
- Takeshi Yamashina
- Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.,Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka, Japan
| | - Yoji Takeuchi
- Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Noriya Uedo
- Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Kenta Hamada
- Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Kenji Aoi
- Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Yasushi Yamasaki
- Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Noriko Matsuura
- Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Takashi Kanesaka
- Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Tomofumi Akasaka
- Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Sachiko Yamamoto
- Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Noboru Hanaoka
- Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Koji Higashino
- Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Ryu Ishihara
- Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Hiroyasu Iishi
- Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
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Shin DK, Shin SY, Park CY, Jin SM, Cho YH, Kim WH, Kwon CI, Ko KH, Hahm KB, Park PW, Kim JW, Hong SP. Optimal Methods for the Management of Iatrogenic Colonoscopic Perforation. Clin Endosc 2016; 49:282-8. [PMID: 26888410 PMCID: PMC4895935 DOI: 10.5946/ce.2015.046] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 05/16/2015] [Accepted: 05/17/2015] [Indexed: 12/23/2022] Open
Abstract
Background/Aims: Colonoscopic perforations have been managed with exploratory laparotomy, and have resulted in some morbidity and mortality. Recently, laparoscopic surgery is commonly performed for this purpose. The aim of this study was to compare the outcomes of several management strategies for iatrogenic colonoscopic perforations. Methods: We retrospectively reviewed the medical records of patients who had been treated for colonoscopic perforation between January 2004 and April 2013 at CHA Bundang Medical Center in Korea. Results: A total of 41 patients with colonoscopic perforation were enrolled. Twenty patients underwent conservative management with a success rate of 90%. Surgical management was performed in 23 patients including two patients who were converted to surgical management after the failure of the initial conservative management. Among 14 patients who underwent surgery at 8 hours after the perforation, there was no considerable difference in adverse outcomes between the laparotomy group and the laparoscopic surgery group. The medical costs and claim rate were 1.45 and 1.87 times greater in the exploratory laparotomy group, respectively. Conclusions: Conservative management of colonoscopic perforation could be an option for patients without overt symptoms of peritonitis or with a small defect size. If surgical management is required, laparoscopic surgery may be considered as the initial procedure even with a delayed diagnosis.
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Affiliation(s)
- Dae Kyu Shin
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Sun Young Shin
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Chi Young Park
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Sun Mi Jin
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Yang Hyun Cho
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Won Hee Kim
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Chang-Il Kwon
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Kwang Hyun Ko
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Ki Baik Hahm
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Pil Won Park
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Jong Woo Kim
- Department of Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Sung Pyo Hong
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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Hirasawa K, Sato C, Makazu M, Kaneko H, Kobayashi R, Kokawa A, Maeda S. Coagulation syndrome: Delayed perforation after colorectal endoscopic treatments. World J Gastrointest Endosc 2015; 7:1055-1061. [PMID: 26380051 PMCID: PMC4564832 DOI: 10.4253/wjge.v7.i12.1055] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 07/18/2015] [Accepted: 08/31/2015] [Indexed: 02/05/2023] Open
Abstract
Various procedure-related adverse events related to colonoscopic treatment have been reported. Previous studies on the complications of colonoscopic treatment have focused primarily on perforation or bleeding. Coagulation syndrome (CS), which is synonymous with transmural burn syndrome following endoscopic treatment, is another typical adverse event. CS is the result of electrocoagulation injury to the bowel wall that induces a transmural burn and localized peritonitis resulting in serosal inflammation. CS occurs after polypectomy, endoscopic mucosal resection (EMR), and even endoscopic submucosal dissection (ESD). The occurrence of CS after polypectomy or EMR varies according previous reports; most report an occurrence rate around 1%. However, artificial ulcers after ESD are largely theoretical, and CS following ESD was reported in about 9% of cases, which is higher than that for CS after polypectomy or EMR. Most cases of post-polypectomy syndrome (PPS) have an excellent prognosis, and they are managed conservatively with medical therapy. PPS rarely develops into delayed perforation. Delayed perforation is a severe adverse event that often requires emergency surgery. Since few studies have reported on CS and delayed perforation associated with CS, we focused on CS after colonoscopic treatments in this review. Clinicians should consider delayed perforation in CS patients.
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31
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Conservative Management of Large Rectosigmoid Perforation under Peritoneal Reflection: Case Report and Review of the Literature. Case Rep Surg 2015; 2015:364576. [PMID: 25918665 PMCID: PMC4396719 DOI: 10.1155/2015/364576] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Revised: 03/09/2015] [Accepted: 03/25/2015] [Indexed: 02/08/2023] Open
Abstract
Colonoscopy is accepted as the best method in diagnosis, treatment, and follow-up of colorectal diseases. As the amount of the usage of diagnostic and therapeutic colonoscopy rises, iatrogenic complications are more likely to be seen. The most important complications are perforations and bleeding. Whereas perforation is a complication that is seen rarely, because of the high ratio of morbidity and mortality, it should be analyzed more carefully. There is not a common view on the optimal treatment of colonoscopic perforation. Most cases require urgent surgery, and in some cases the iatrogenic perforation of colon can be managed by conservative methods. In this report, we present a rectosigmoid perforation under peritoneal reflection and conservative management of this case.
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32
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Prevalence and clinical features of coagulation syndrome after endoscopic submucosal dissection for colorectal neoplasms. Dig Dis Sci 2015; 60:211-6. [PMID: 25502119 DOI: 10.1007/s10620-014-3484-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 12/06/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVES There are several published studies examining the major complications (bleeding and perforation) of colon endoscopic submucosal dissection (ESD). However, little is known about the other complications, such as post-ESD coagulation syndrome (CS). The aims of this study were to evaluate the prevalence and the clinical features of CS after colon ESD. METHODS There were 183 cases treated with ESD for either a colorectal laterally spreading tumor or a polypoid mass in Konkuk University Medical Center. There were 151 cases enrolled in this study after excluding patients with perforation, bleeding, nonlifting sign, or nonneoplastic lesions. Patients with a fever above 37.7 °C, abdominal pain, and localized tenderness after ESD without macro- or microperforation, regardless of the symptoms of peritoneal irritation, were deemed as showing post-colon ESD CS. RESULTS There were 151 cases enrolled in this study, and 13 patients (8.6 %) showed CS after colorectal ESD. There were no differences in the demographic and endoscopic characteristics between the patients with CS and those without CS. The mean hospitalization stay was 3.0 ± 0.3 days longer in the CS (+) group (6.9 ± 1.9 days) than that in the CS (-) group (3.9 ± 1.6 days) (p = 0.001). All patients with CS were treated with conservative, nonsurgical management, such as fasting and intravenous antibiotics. CONCLUSIONS The rate of post-ESD CS was less than 9 % in this study. Although CS occurred, all of the patients with CS showed a favorable progression within 1 week.
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Hong MJ, Kim JH, Lee SY, Sung IK, Park HS, Shim CS. Prevalence and clinical features of coagulation syndrome after endoscopic submucosal dissection for colorectal neoplasms. Dig Dis Sci 2015. [PMID: 25502119 DOI: 10.1007/s10620-014-3484-3489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND OBJECTIVES There are several published studies examining the major complications (bleeding and perforation) of colon endoscopic submucosal dissection (ESD). However, little is known about the other complications, such as post-ESD coagulation syndrome (CS). The aims of this study were to evaluate the prevalence and the clinical features of CS after colon ESD. METHODS There were 183 cases treated with ESD for either a colorectal laterally spreading tumor or a polypoid mass in Konkuk University Medical Center. There were 151 cases enrolled in this study after excluding patients with perforation, bleeding, nonlifting sign, or nonneoplastic lesions. Patients with a fever above 37.7 °C, abdominal pain, and localized tenderness after ESD without macro- or microperforation, regardless of the symptoms of peritoneal irritation, were deemed as showing post-colon ESD CS. RESULTS There were 151 cases enrolled in this study, and 13 patients (8.6 %) showed CS after colorectal ESD. There were no differences in the demographic and endoscopic characteristics between the patients with CS and those without CS. The mean hospitalization stay was 3.0 ± 0.3 days longer in the CS (+) group (6.9 ± 1.9 days) than that in the CS (-) group (3.9 ± 1.6 days) (p = 0.001). All patients with CS were treated with conservative, nonsurgical management, such as fasting and intravenous antibiotics. CONCLUSIONS The rate of post-ESD CS was less than 9 % in this study. Although CS occurred, all of the patients with CS showed a favorable progression within 1 week.
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Affiliation(s)
- Mi Jin Hong
- Department of Internal Medicine, Digestive Disease Center, Konkuk University School of Medicine, Konkuk University Medical Center, 120-1 Neungdong-ro, Hwayang-dong, Gwangjin-gu, Seoul, 143-729, Korea
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Kaimakliotis PZ, Chandrasekhara V. Endoscopic mucosal resection and endoscopic submucosal dissection of epithelial neoplasia of the colon. Expert Rev Gastroenterol Hepatol 2014; 8:521-31. [PMID: 24661135 DOI: 10.1586/17474124.2014.902305] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Endoscopic mucosal resection (EMR) with curative intent has evolved into a safe and effective technique and is currently the gold standard for management of large colonic epithelial neoplasms. Piecemeal EMR is associated with a high risk of local recurrence requiring vigilant surveillance and repeat interventions. Endoscopic submucosal dissection (ESD) was introduced in Japan for the management of early gastric cancer, and has recently been described for en bloc resection of colonic lesions greater than 20 mm. En bloc resection allows accurate histological assessment of the depth of invasion, minimizes the risk of local recurrence and helps determine additional therapy. Morphologic classification of lesions prior to resection allows prediction of depth of invasion and risk of nodal metastasis, allowing selection of the appropriate intervention. This review provides an overview of the assessment of epithelial neoplasms of the colon and the application of EMR and ESD techniques in their management.
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Affiliation(s)
- Pavlos Z Kaimakliotis
- Gastroenterology Division, University of Pennsylvania Health System, Philadelphia, PA, USA
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Postpolypectomy electrocoagulation syndrome: a mimicker of colonic perforation. Case Rep Emerg Med 2013; 2013:687931. [PMID: 23956889 PMCID: PMC3728495 DOI: 10.1155/2013/687931] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Accepted: 06/26/2013] [Indexed: 02/07/2023] Open
Abstract
Postpolypectomy electrocoagulation syndrome is a rare complication of polypectomy with electrocautery and is characterized by a transmural burn of the colon wall. Patients typically present within 12 hours after the procedure with symptoms mimicking colonic perforation. Presented is the case of a 56-year-old man who developed abdominal pain six hours after colonoscopy during which polypectomy was performed using snare cautery. CT imaging of the abdomen revealed circumferential thickening of the wall of the transverse colon without evidence of free air. The patient was treated conservatively as an outpatient and had resolution of his pain over the following four days. Recognition of the diagnosis and understanding of the treatment are important to avoid unnecessary exploratory laparotomy or hospitalization.
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Metz AJ, Moss A, McLeod D, Tran K, Godfrey C, Chandra A, Bourke MJ. A blinded comparison of the safety and efficacy of hot biopsy forceps electrocauterization and conventional snare polypectomy for diminutive colonic polypectomy in a porcine model. Gastrointest Endosc 2013. [PMID: 23199650 DOI: 10.1016/j.gie.2012.09.014] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Although linked with perforation, serositis, delayed bleeding, and incomplete resection, hot biopsy forceps electrocauterization (HBF) is still widely used for diminutive colonic polypectomy. OBJECTIVE To evaluate the safety and efficacy of HBF in comparison with conventional snare polypectomy (CSP). DESIGN Randomized, blinded, controlled trial. SETTING Academic endoscopy unit. SUBJECTS Ten swine. INTERVENTION Eighty-two paired polypectomies (41 HBF, 41 CSP) of small, minimally elevated, artificial lesions. Standardized technique using coagulating current at 25 W. HBF: the tissue was avulsed after 1 to 2 seconds of current caused blanching of the artificial pedicle. CSP: the polyp was removed by snare diathermy. MAIN OUTCOME MEASUREMENTS Histopathology of resected specimens and polypectomy sites in colectomy specimens at necropsy (lateral mucosal and depth of ulceration, necrosis and inflammation). RESULTS Some (21%) of the HBF specimens were ablated and uninterpretable. All CSP specimens yielded interpretable specimens. Mucosal necrosis adjacent to HBF resection sites varied widely, between 1.5 and 9 mm (mean 5.7 mm, standard deviation ± 2). There was visible mucosa under the HBF ulcer in 14% of cases. The depth of necrosis in the colon wall was significantly different between the two techniques, with partial muscularis propria (MP) necrosis in 14 of 41 lesions (34%) with HBF, compared with 1 of 41 (2%) of CSP (P < .001), and full-thickness MP necrosis in 9 of 41 lesions (22%) with HBF, compared with 1 of 41 (2%) of CSP (P = .014). There was full-thickness MP inflammation in 13 of 41 lesions (32%) with HBF compared with 5 of 41 (12%) of CSP (P = .06). Transmural subserosal inflammation was seen in 13 of 41 lesions (32%) with HBF compared with 4 of 41 (10%) of CSP (P = .027). There was no relationship between visible lateral mucosal injury and depth of injury (rs = -0.07). LIMITATIONS Animal study. CONCLUSION Despite use of the standardized HBF technique, there is a wide range of lateral mucosal and deep thermal injury as well as residual target mucosa. HBF also results in a significantly greater depth of tissue injury, with a high proportion of transmural necrosis. Ensuring minimal blanching of the mucosa during the procedure does not protect from deep injury. In comparison to conventional snare polypectomy, HBF is imprecise, potentially ineffective, and hazardous.
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Affiliation(s)
- Andrew J Metz
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
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Lin YC, Lin WP, Huang JY, Lee SY. Polymicrobial peritonitis following colonoscopic polypectomy in a peritoneal dialysis patient. Intern Med 2012; 51:1841-3. [PMID: 22821097 DOI: 10.2169/internalmedicine.51.7485] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Patients undergoing continuous ambulatory peritoneal dialysis (CAPD) are at an increased risk of peritonitis following colonoscopy with or without polypectomy. Guidelines for peritoneal dialysis patients recommend administration of prophylactic antibiotics and drainage of the abdomen before colonoscopy. In this report, we describe a 53-year-old woman on CAPD who underwent colonoscopy with polypectomy and developed peritonitis within 24 hours. She presented with severe abdominal pain, typical rebounding tenderness, and turbid dialysate containing increased white blood cells with a predominance of neutrophils. A culture of the patient's peritoneal fluid grew polymicrobial species including Escherichia coli, Klebsiella pneumoniae, and Enterococcus faecalis. She was treated with intraperitoneal and intravenous administration of combination antibiotics, and she fully recovered within 3 weeks. We suggest that nephrologists and endoscopists should be familiar with the risks and follow the guidelines to prevent such complications in CAPD patients. If peritonitis occurs, medical therapy with antibiotics should be considered before surgical intervention for catheter salvage.
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Affiliation(s)
- Yu-Cheng Lin
- Department of Nephrology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taiwan
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38
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Lee H, Cheoi KS, Chung H, Park JC, Shin SK, Lee SK, Lee YC. Clinical features and predictive factors of coagulation syndrome after endoscopic submucosal dissection for early gastric neoplasm. Gastric Cancer 2012; 15:83-90. [PMID: 21761134 DOI: 10.1007/s10120-011-0073-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Accepted: 06/04/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Various endoscopic submucosal dissection (ESD)-related complications, such as perforation or bleeding, occur frequently. However, the clinical course of coagulation syndrome (CS) after ESD is not known. The aim of this study was to clarify the clinical outcomes and predictive factors of CS after ESD for early gastric lesions. METHODS ESD procedures were performed in the typical sequence (marking, incision, and submucosal dissection). Four hundred and ninety-five patients with early gastric neoplasms were classified into two groups based on their clinical course after ESD: one group with post-ESD CS and the other with a normal clinical course. The clinical outcomes of the CS group were analyzed, and various clinical and pathological factors related to post-ESD CS were investigated using univariate and multivariate analyses. RESULTS Coagulation syndrome occurred after ESD in 35 patients. In the CS group, the median period of inflammatory symptoms was 23.7 ± 12.0 h, and no blood cultures showed bacteremia. Multivariate analysis demonstrated that a tumor size of more than 1.5 cm [odds ratio (OR) 5.99, P < 0.001], tumor location in the middle third of the stomach (OR 2.84, P = 0.005), and a procedural time longer than 45 min (OR 2.71, P = 0.033) were independent risk factors for this complication. All patients with CS presented with a favorable outcome, irrespective of antibiotic treatment. CONCLUSIONS This study suggests that CS occurs with an incidence of 7.1% after ESD for gastric lesions, and the factors associated with post-ESD CS include tumor size and location, and procedural duration.
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Affiliation(s)
- Hyuk Lee
- Division of Gastroenterology, Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, 134 Shinchon-dong, Sodaemun-gu, Seoul, Korea
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Day LW, Kwon A, Inadomi JM, Walter LC, Somsouk M. Adverse events in older patients undergoing colonoscopy: a systematic review and meta-analysis. Gastrointest Endosc 2011; 74:885-96. [PMID: 21951478 PMCID: PMC3371336 DOI: 10.1016/j.gie.2011.06.023] [Citation(s) in RCA: 175] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2011] [Accepted: 06/20/2011] [Indexed: 02/06/2023]
Abstract
BACKGROUND Studies suggest that advancing age is an independent risk factor for experiencing adverse events during colonoscopy. Yet many of these studies are limited by small sample sizes and/or marked variation in reported outcomes. OBJECTIVE To determine the incidence rates for specific adverse events in elderly patients undergoing colonoscopy and calculate incidence rate ratios for selected comparison groups. SETTING AND PATIENTS Elderly patients undergoing colonoscopy. DESIGN Systematic review and meta-analysis. MAIN OUTCOME MEASUREMENTS Perforation, bleeding, cardiovascular (CV)/pulmonary complications, and mortality. RESULTS Our literature search yielded 3328 articles, of which 20 studies met our inclusion criteria. Pooled incidence rates for adverse events (per 1000 colonoscopies) in patients 65 years of age and older were 26.0 (95% CI, 25.0-27.0) for cumulative GI adverse events, 1.0 (95% CI, 0.9-1.5) for perforation, 6.3 (95% CI, 5.7-7.0) for GI bleeding, 19.1 (95% CI, 18.0-20.3) for CV/pulmonary complications, and 1.0 (95% CI, 0.7-2.2) for mortality. Among octogenarians, adverse events (per 1000 colonoscopies) were as follows: cumulative GI adverse event rate of 34.9 (95% CI, 31.9-38.0), perforation rate of 1.5 (95% CI, 1.1-1.9), GI bleeding rate of 2.4 (95% CI, 1.1-4.6), CV/pulmonary complication rate of 28.9 (95% CI, 26.2-31.8), and mortality rate of 0.5 (95% CI, 0.06-1.9). Patients 80 years of age and older experienced higher rates of cumulative GI adverse events (incidence rate ratio 1.7; 95% CI, 1.5-1.9) and had a greater risk of perforation (incidence rate ratio 1.6, 95% CI, 1.2-2.1) compared with younger patients (younger than 80 years of age). There was an increased trend toward higher rates of GI bleeding and CV/pulmonary complications in octogenarians but neither was statistically significant. LIMITATIONS Heterogeneity of studies included and not all complications related to colonoscopy were captured. CONCLUSIONS Elderly patients, especially octogenarians, appear to have a higher risk of complications during and after colonoscopy. These data should inform clinical decision making, the consent process, public health policy, and comparative effectiveness analyses.
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Colonoscopic perforation: useful parameters for early diagnosis and conservative treatment. Int J Colorectal Dis 2011; 26:1183-90. [PMID: 21526372 DOI: 10.1007/s00384-011-1211-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/11/2011] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The purpose of this study is to determine useful parameters for the early diagnosis of colonoscopic perforation and to select those who would require surgical treatment. METHODS We retrospectively reviewed the demographics, clinical and colonoscopic data, diagnostic-surgical interval, operative findings, complications, and hospital stay of patients who developed postcolonoscopy iatrogenic colonic perforation between January 2002 and December 2008. RESULTS A retrospective multicentric study of patients diagnosed of colonoscopic perforation was performed. Fifty-four patients were found for final analysis (mean age, 71 years (26-91 years). Thirty-four were diagnostic and 20 were therapeutic colonoscopies. Most patients in whom the perforation was noticed during colonoscopy were treated surgically (p = 0.032) within 24 h (p = 0.004) and had a lesser degree of surgical peritonitis (p = 0.033). Those with deficient bowel preparation had more interventions (p < 0.05), ostomies (p = 0.015), and complications (p = 0.023) as well as major clinical (p < 0.001) and surgical peritonitis (p = 0.031). Patients with nonoperative management had fewer complications (p = 0.011) and lower hospital stay (p < 0.048). Surgical treatment within 24 h resulted in a lesser degree of surgical peritonitis (p < 0.001), fewer intestinal resections (p < 0.001), ostomies (p = 0.002) and complications (p < 0.047), and shorter hospital stay (p < 0.05). CONCLUSIONS We recommend a conservative treatment for patients with the following conditions: good general health, unnoticed perforation during endoscopy, early diagnosis, no signs of diffuse peritonitis, proper colonic preparation, and a different injury mechanism to traction. Patients treated surgically after the first 24 h are likely to have a greater degree of peritonitis and more intestinal resections, ostomies, and complications.
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Abstract
AIM Adequate colonic imaging is generally an invasive procedure with attendant risks, particularly perforation. Endoscopy, barium enema and computed tomographic colonography (CTC) are the main techniques for investigating patients with symptoms of, or screening for, colorectal cancer. The potential complications of these investigations have to be weighed against the benefits. This article reviews the literature on the incidence, presentation and management of iatrogenic colonic perforation at colonic imaging. METHOD A literature review of relevant studies was undertaken using PubMed, Cochrane library and personal archives of references. Manual cross-referencing was performed, and relevant references from selected articles were reviewed. Studies reporting complications of endoscopy, barium enema and CT colonography were included in this review. RESULTS Twenty-four studies were identified comprising 640,433 colonoscopies, with iatrogenic perforation recorded in 585 patients (0.06%). The reported perforation rate with double-contrast barium enema was between 0.02 and 0.24%. Serious complications with CTC were infrequent, though nine perforations were reported in a case series of 24,365 patients (0.036%) undergoing CTC. CONCLUSION Perforation remains an infrequent and almost certainly under-reported, complication of all colonic imaging modalities. Risk awareness, early diagnosis and active management of iatrogenic perforation minimizes an adverse outcome.
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Affiliation(s)
- J S Khan
- Queen Alexandra Hospital, Portsmouth, UK.
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Abstract
Outpatient colonoscopy has been proven safe but can rarely be associated with serious complications. The addition of polypectomy to the procedure increases the incidence of all complications with hemorrhage accounting for approximately half. The use of electrocautery for hot biopsy or polyp removal can result in a full-thickness burn without perforation in approximately 1 per cent of cases and typically presents as focal peritonitis without pneumoperitoneum. This so-called “postpolypectomy syndrome” or “serositis” is often successfully managed medically with resolution of symptoms in 24 to 48 hours. Bowel perforation occurs in less than 1 per cent of patients but requires emergent laparotomy. Appendicitis, both acute and perforated, has been reported as a rare complication of colonoscopy.
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Affiliation(s)
| | - Jerad P. Miller
- Department of Surgery, Mount Carmel Health System, Columbus, Ohio
| | | | - Phillip D. Price
- Department of Surgery, Mount Carmel Health System, Columbus, Ohio
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Oh JE, Shim SG. [Colonoscopic perforation; a 10-year experience in single general hospital]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2010; 54:371-6. [PMID: 20026891 DOI: 10.4166/kjg.2009.54.6.371] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND/AIMS Colonoscopy is the principal method for diagnosis, treatment, and follow up of colorectal disease. The study aimed to assess the incidence, clinical features, and management of colonoscopic perforations at a local general hospital. METHODS A retrospective review of patient record was performed for all patients with iatrogenic colonic perforation after sigmoidoscopy and colonoscopy between 1997 and 2007. RESULTS In the 10-year period, 16,388 colonoscopic and sigmoidscopic procedure were performed. All 10 cases of procedure related colonic perforation were developed. Perforation occurred in 9 cases during therapeutic procedure; 5 cases due to polypectomy and 4 cases due to endoscopic submucosal dissection. Perforation occurred in one case during diagnostic procedure. CONCLUSIONS Therapeutic procedure is a clear risk factor of colonic perforation. When colonic perforation occurs, we should be able to make early diagnosis. Early diagnosis can lead to a good treatment and can produce good prognosis with short hospital days.
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Affiliation(s)
- Ji Eun Oh
- Department of Gastroenterology, Masan Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Is endoscopic closure with clips effective for both diagnostic and therapeutic colonoscopy-associated bowel perforation? Surg Endosc 2009; 24:1177-85. [PMID: 19915907 DOI: 10.1007/s00464-009-0746-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Accepted: 10/12/2009] [Indexed: 02/07/2023]
Abstract
BACKGROUND Colonic perforation is an uncommon but serious colonoscopy-associated complication. This study assessed the effectiveness of conservative management with endoscopic clipping for colonoscopy-associated perforations. METHODS Clinical manifestations and management outcomes were assessed for 38 patients with colonoscopy-associated colonic perforations that occurred between January 2001 and April 2008 at the Asan Medical Center, Seoul, Korea. These perforations were classified as endoscopically evident, endoscopically suspected, and radiologically proven. RESULTS Of the 38 perforations, 19 were endoscopically evident, 9 were endoscopically suspected, and 10 were radiologically proven but without endoscopic evidence. Of the 19 patients with endoscopically evident perforations, 13 (68.4%) underwent endoscopic closure with clips, and all improved without surgery. All nine patients with endoscopically suspected perforations underwent endoscopic closure, and eight (88.9%) improved without surgery. Of the 10 radiologically proven perforations, 7 were detected within 1 day after colonoscopy. All the patients improved without surgery. However, two of the three patients with delayed perforations required emergency laparotomy. Consequently, of the 38 patients with perforations, 29 (76.3%) improved without surgery. Of the 28 patients with endoscopically evident or suspected perforations, conservative management was successful for 21 (95.5%) of the 22 patients with effective clipping, but for none (0%) of the 6 patients without clipping. CONCLUSIONS Conservative management by immediate endoscopic closure with clips can be effective for the treatment of colonic perforations detected during colonoscopy. Conservative management also may be tried cautiously for stable patients who have radiologically proven colonoscopy-associated perforations without endoscopic evidence.
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The role of laparoscopy in the treatment of complications after colonoscopy. Surg Laparosc Endosc Percutan Tech 2009; 18:561-4. [PMID: 19098660 DOI: 10.1097/sle.0b013e318182b025] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Perforations of the colonic wall or splenic injury during colonoscopy are rare complications. Treatment of these complications by laparoscopy is an advisable compromise instead of an invasive surgery with a laparotomy or a noninvasive and potentially risky nonoperative therapy. All surgical procedures that can be performed by open approach can also be performed laparoscopically. We present in this report 15 patients who were treated for a perforation after colonoscopy. In addition, 2 cases of splenic injury after colonoscopy are described. Twelve perforations were sutured laparoscopically and 3 perforations were sutured via laparotomy. Except for 1 minor wound infection, there were no complications. One splenic injury was treated by spleen wrapping via an open approach due to former pancreatic surgery, and 1 injury was treated laparoscopically with a hemostypticum. Mortality was 0%. Early laparoscopic intervention is a safe and effective method in the treatment of serious complications after colonoscopy.
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Arora G, Mannalithara A, Singh G, Gerson LB, Triadafilopoulos G. Risk of perforation from a colonoscopy in adults: a large population-based study. Gastrointest Endosc 2009; 69:654-64. [PMID: 19251006 DOI: 10.1016/j.gie.2008.09.008] [Citation(s) in RCA: 189] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Accepted: 09/05/2008] [Indexed: 02/07/2023]
Abstract
BACKGROUND Previous studies that reported the incidence of perforation from a colonoscopy are limited by small sample sizes, restricted age groups, or single-center data. OBJECTIVE To determine the incidence and risk factors of colonic perforation from a colonoscopy in a large population cohort. DESIGN Retrospective, population-based, cohort study, followed by a nested case-control study. SETTING California Medicaid program claims database. PATIENTS A total of 277,434 patients (aged 18 years and older) who underwent a colonoscopy during 1995 to 2005, age, sex, and time matched to 4 unique general-population controls. MAIN OUTCOME MEASUREMENTS Perforation incidence in the 7 days after colonoscopy (or matched index date for controls) with odds ratio (OR); multivariate logistic regression to calculate adjusted ORs for subsequent analysis of risk factors. RESULTS A total of 228 perforations were diagnosed after 277,434 colonoscopies, which corresponded to a cumulative 7-day incidence of 0.082%. The OR of getting a perforation from a colonoscopy compared with matched controls (n = 1,072,723) who did not undergo a colonoscopy was 27.6 (95% CI, 19.04-39.92), P < .001. On multivariate analysis, when comparing the group that had a perforation after a colonoscopy (n = 216) with those who did not (n = 269,496), increasing age, significant comorbidity, obstruction as an indication for the colonoscopy, and performance of invasive interventions during colonoscopy were significant positive predictors. Performance of biopsy or polypectomy did not affect the perforation risk. The rate of perforation did not change significantly over time. LIMITATIONS Validity of coding and capturing of all perforation diagnoses may possibly be deficient. CONCLUSION The risk of perforation from a colonoscopy is low, but, despite increased experience with the procedure, it remains unchanged over time.
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Affiliation(s)
- Gaurav Arora
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California 94305-5187, USA
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Schurr MO, Hartmann C, Kirschniak A, Ho CN, Fleisch C, Buess G. [Experimental study on a new method for colonoscopic closure of large-bowel perforations with the OTSC clip]. ACTA ACUST UNITED AC 2008; 53:45-51. [PMID: 18979620 DOI: 10.1515/bmt.2008.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Iatrogenic perforation of the colon during interventional endoscopic procedures, e.g., mucosectomy, is a problematic complication, as safe treatment often requires surgical repair. Iatrogenic perforation of the colon is indeed a rare complication; however, given the increasing case numbers in interventional endoscopy it is of considerable practical relevance. The closure of perforations can be achieved with conventional endoscopic clips; however, these working channel based clips are often too small to close a perforation securely. Therefore, we have developed a novel endoscopic clipping system that can be attached to the tip of the endoscope. This over-the-scope-clip system (OTSC), made of Nitinol, was tested in an experimental trial (domestic pig, 50-60 kg) for its applicability for perforation closure. In acute experiments, tight endoscopic closure of 10 perforations in five animals was demonstrated; perforations were made through repeat biopsy. In three further animals, the postoperative course was studied over a period of 2 weeks. Peritonitis was not found in any of these animals. The local healing result at the site of implantation was good. Clips were present 2 weeks after the procedure. In this experimental study, the OTSC clip system was found to be a simple and secure method of iatrogenic colon perforation closure.
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Affiliation(s)
- Marc O Schurr
- Steinbeis Hochschule Berlin, IHCI-Institut, Tübingen, Deutschland.
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Avgerinos DV, Llaguna OH, Lo AY, Leitman IM. Evolving management of colonoscopic perforations. J Gastrointest Surg 2008; 12:1783-9. [PMID: 18683006 DOI: 10.1007/s11605-008-0631-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2008] [Accepted: 07/16/2008] [Indexed: 01/31/2023]
Abstract
BACKGROUND Perforations of the large bowel during diagnostic or therapeutic colonoscopy are a rare but significant complication. Their treatment has evolved over the last decade, but there are still no specific guidelines for their optimal management. MATERIALS AND METHODS Retrospective review of 105,786 consecutive colonoscopies performed in a 21-year period allowed assessment of the medical records in all patients treated at our institution for colonoscopic perforation. RESULTS Thirty-five patients suffered perforation (perforation rate 0.033%) during colonoscopy from January 1986 to October 2007 (14 men, 21 women; mean age 69.4 years). Twenty-four of the perforations occurred during diagnostic colonoscopy, whereas 11 during therapeutic colonoscopy. Twenty-three (66%) of the patients underwent operative treatment and 12 (34%) were managed nonoperatively. The average length of stay was 15.2 days, and there was one death (2.9% 30-day mortality rate) among the patients. CONCLUSIONS Perforations from diagnostic colonoscopy usually are large enough to warrant surgical management, whereas perforations from therapeutic colonoscopy usually are small, leading to successful nonoperative treatment. Over the last decade, the surgical treatment of colonoscopic perforations has evolved, as there has been a trend that favors primary repair versus bowel resection with successful outcome. Careful observation and clinical care adherent to strict guidelines for patients treated nonoperatively is appropriate in order to minimize morbidity and mortality and identify early those who may benefit from operation. Each treatment, however, has to be individualized according to the patients' comorbidities and clinical status, as well as the specific conditions during the colonoscopy that lead to the perforation.
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Affiliation(s)
- Dimitrios V Avgerinos
- Department of Surgery, Beth Israel Medical Center, Albert Einstein College of Medicine, New York, NY 10003, USA.
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Ballas KD, Rafailidis SF, Triantaphyllou A, Symeonidis N, Pavlidis TE, Psarras K, Marakis GN, Sakadamis AK. Retroperitoneal, mediastinal, and subcutaneous emphysema, complicating colonoscopy and rectal polypectomy. J Laparoendosc Adv Surg Tech A 2008; 18:717-720. [PMID: 18803515 DOI: 10.1089/lap.2008.0003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Complications of flexible endoscopy-though still rare-are increasing in frequency lately as more invasive procedures are routinely performed. Perforation, hemorrhage, coagulation disorders, thrombophlebitis, and splenic rupture have all been reported to complicate colonoscopy and colorectal polypectomies. In this paper, we report on a case of retroperitoneal, mediastinal, and neck surgical emphysema, complicating colonoscopy and rectal polypectomy, presented initially as a change in the voice and facial swelling.
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Affiliation(s)
- Konstantinos D Ballas
- The 2nd Propedeutical Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece
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