Feasibility of endoscopic closure of an iatrogenic colon perforation occurring during colonoscopy

Background: Colon perforation is one of the most dreaded complications of colonoscopy. Traditionally, patients with a colon perforation have been treated surgically. Although there are several case reports documenting the usefulness of endoscopic closure of colon perforations, there are few current data evaluating the feasibility of endoscopic closure for an iatrogenic perforation on consecutive patients undergoing colonoscopy.. Objective: To assess the incidence of colon perforations and the utility of immediate endoscopic closure during colonoscopy. Design: Retrospective, observational study. Setting: Tertiary-care academic medical center. Patients: All patients who underwent colonoscopy at 1 institution from June 2002 to December 2008 were identified. Intervention: An attempt at immediate colon perforation closure by endoscopic means. Main Outcome Measurements: Successful endoscopic closure of colon perforation. Results: During the study period, a total of 8601 colonoscopies were performed (2472 therapeutic interventions, 28.7%). A total of 12 iatrogenic colon perforations occurred, yielding a rate of 1.4/1000. Five (41.7%) occurred during a diagnostic colonoscopy (0.8/1000), and 7 perforations (58.3%) occurred as the result of a therapeutic intervention (2.8/1000). Endoscopic closure of the perforation site was possible in 5 patients (42%). Seven patients were treated surgically (large defects [n = 3], including 1 failed endoscopic closure, difficult endoscope position [n = 2], stool contamination [n = 1], and endoscopist's inexperience with closure of mucosal defects [n = 1]. Limitation: Retrospective design. Conclusions: In this study, the incidence of colon perforations was 1.4/1000. Endoscopic closure of iatrogenic colon perforations was attempted in 50% of patients and was successful in 83%. All patients with successful endoscopic closure had lesions smaller than 10 mm. (Gastrointest Endosc 2011;73:550-5.)