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COLONOSCOPY PERFORATION RATES AND OUTCOMES: 6-YEAR EXPERIENCE AT THE UNIVERSITY OF WESTERN ONTARIO
L McKnight, J Gregor, C Vinden
University of Western Ontario, London, Ontario
Aims: Despite advances in training and equipment for colonoscopy, endoscopic perforation remains a feared complication. Rates of perforation cited to patients often derive from historical cohorts and may have limited applicability to our patient population. The aim of this study was to provide patients with current data regarding epidemiologic characteristics and surgical outcomes of this important complication.
Methods: We searched our medical records database using the ICD-10 endoscopic perforation codes Y60.4 and T81.2 for the period of April 1, 2002 to March 31, 2008. 76 charts were identified as possible colonoscopy perforations. Upon hand-review of these charts, 14 patients were found to have complications of procedures other than endoscopy, 12 had complications of upper GI endoscopy, and 12 had complications of colonoscopy other than perforation. A total of 38 colonoscopy perforations were therefore identified, of which 2 were microperforations. Information collected includes patient demographics, timing of presentation and surgical outcomes. Perforation rates were calculated on a yearly basis, since accurate numbers of total procedures performed were not available for all 6 years examined.
Results: In the 2007/2008 fiscal year, the rate of perforation was 0.96 per 1000 procedures. Over the entire period examined, 18 men and 20 women suffered colonoscopy perforations, with a mean age at presentation of 65.3 years. 9 patients (24%) were inpatients at the time of their procedure. The diagnosis of colonic perforation was suspected during the procedure in 14 cases (37%), in the recovery room in 10 cases (26%), and after discharge home in 14 cases (37%). All patients with confirmed perforation were admitted to hospital with a mean length of stay of 10.5 days. The most common injury was sigmoid perforation by the shaft of the endoscope, which occured in 9 cases (24%). The two patients with microperforation and one additional patient with a moderate amount of free air on X-ray improved without the need for surgical intervention. Of the remaining 35 patients who underwent surgical repair, 23 underwent a bowel resection (66%), while 12 underwent primary repair (34%). 11 patients (31%) required a colostomy or ileostomy. One patient died following perforation, for a case fatality of 2.6%.
Conclusions: Perforation is the most important potential risk associated with colonoscopy. Our rate of perforation was 0.96 per 1000 procedures, which is similar to rates cited in historical cohorts. Patients should be informed that in the event of perforation, their symptoms may not become apparent until discharge home. Following a diagnosis of perforation, most patients (92%) require surgery, and a significant number (31%) require colostomy or ileostomy.