Analysis of colonoscopic perforations at a local clinic and a tertiary hospital

Table 1 Frequency of perforation depending on the type of endoscopic procedure

		Total	Diagnostic	Therapeutic	Polypectomy	EMR	ESD
Shirakawa Clinic between April 2006 and December 2010
Number	n	10  826	8201	2625	1609	885	131
Perforation	n (%)	8 (0.07)	0 (0)	8 (0.3)	1 (0.06)	2 (0.2)	5 (3.8)
Maebashi Red Cross Hospital between January 1996 and December 2010
Number	n	32  148	24  361	7787	5500	2244	43
Perforatio	(%)	9 (0.03)	3 (0.01)	6 (0.08)	1 (0.02)	4 (0.17)	1 (2.3)

EMR: Endoscopic mucosal resection; ESD: Endoscopic submucosal dissection.

Table 2 The cases with iatrogenic perforation at the Shirakawa Clinic

Case	Age	Gender	Procedure	Site of perforation	Disease	Discovery of perforation	Abdominal pain	Peritonitis sign	Extrabowel gasses	Treatment	Max body temperature (°C)	CRP (mg/dL)	Cessation of food intake (d)	Intravenous antibiotics treatment (d)	Total hospital stay (d)
1	71	F	EMR	Ascending	Adenocarcinoma	Just after procedure	+	No	Free air	Conservative (with clipping)	36.9	4.4	1	6	7
2	57	M	ESD	Ascending	Adenocarcinoma	During	-	No	Free air	Conservative (with clipping)	36.8	0.9	1	4	9
3	69	F	ESD	Caecum	Adenoma	During	-	No	PP1	Conservative (with clipping)	37.5	3.8	2	8	13
4	66	M	ESD	Rectm (Rb)	Adenoma	Just after procedure	-	No	PP	Conservative (without clipping)	37.9	17.9	1	6	12
5	80	M	ESD	Caecum	Adenoma	Just after procedure	-	No	Free air	Conservative (without clipping)	37.0	4.2	2	6	10
6	68	M	Polypectomy	Transverse	Adenoma	1 d after procedure	+	Located	Free air	Conservative (without clipping)	36.9	11	4	7	10
7	64	M	EMR	Ascending	Adenocarcinoma	2 d after procedure	+	Located	Free air	Conservative (without clipping)	36.9	5.5	4	6	11
8	64	F	ESD	Ascending	Adenocarcinoma	During	+	Located	Free air	Conservative (with clipping)	37.2	2.4	3	5	11

¹Pneumoretroperitoneum. EMR: Endoscopic mucosal resection; ESD: Endoscopic submucosal dissection; CRP: C-reactive protein; M: Male; F: Female.

Table 3 Large study of iatrogenic perforation related to colonoscopy n (%)

Ref.	Total	Diagnostic	Therapeutic	Polypectomy	EMR	ESD
Anderson et al[11]	59  987
	22 (0.04)
Cobb et al[10]	43  609
	14 (0.03)
Kaneko et al[24]	3  152  053	2  587  689	564  364	422  119	142  245	ND
	1387 (0.04)	568 (0.02)	819 (1.4)	621 (0.15)	198 (0.14)	ND
Iqbal et al[9]		78  702
		66 (0.84)
Tulchinsky et al[23]	120  067
	7 (0.06)
Lüning et al[7]		30  366
		35 (0.12)
Lüning et al[7]		433  816
		393 (0.09)
Taku et al[8]			15  160	8240	1906	43
			23 (0.15)	4 (0.05)	12 (0.63)	6 (14.0)
Kang et al[6]	44  534	37  762	6772
	53 (0.12)	26 (0.07)	27 (0.40)
Oka et al[22]			71  204	34  433	36  083	688
			62 (0.09)	6 (0.02)	33 (0.09)	23 (3.3)

Upper column: Number of cases; lower column: Perforation (%). EMR: Endoscopic mucosal resection; ESD: Endoscopic submucosal dissection; ND: No data.