Incidence of colonoscopy-related perforation and risk factors for poor outcomes: 3-year results from a prospective, multicenter registry (with videos)
Background and aims Perforation is a life-threatening adverse event of colonoscopy that often requires hospitalization and surgery. We aimed to prospectively assess the incidence of colonoscopy-related perforation in a multicenter registry and to analyze the clinical factors associated with poor cli...
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| Veröffentlicht in: | Surgical endoscopy 2023-08, Vol.37 (8), p.5865-5874 |
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| creator | Lee, Jieun Lee, Yoo Jin Seo, Jong Won Kim, Eun Soo Kim, Sung Kook Jung, Min Kyu Heo, Jun Lee, Hyun Seok Lee, Joon Seop Jang, Byung Ik Kim, Kyeong Ok Cho, Kwang Bum Kim, Eun Young Kim, Dae Jin Chung, Yun Jin |
| description | Background and aims
Perforation is a life-threatening adverse event of colonoscopy that often requires hospitalization and surgery. We aimed to prospectively assess the incidence of colonoscopy-related perforation in a multicenter registry and to analyze the clinical factors associated with poor clinical outcomes.
Methods
This prospective observational study was conducted at six tertiary referral hospitals between 2017 and 2020, and included patients with colonic perforation after colonoscopy. Poor clinical outcomes were defined as mortality, surgery, and prolonged hospitalization (> 13 days). Logistic regression was used to identify factors associated with poor clinical outcomes.
Results
Among 84,673 patients undergoing colonoscopy, 56 had colon perforation (0.66/1000, 95% confidence interval [CI] 0.51–0.86). Perforation occurred in 12 of 63,602 diagnostic colonoscopies (0.19/1000, 95% CI 0.11–0.33) and 44 of 21,071 therapeutic colonoscopies (2.09/1000, 95% CI 1.55–2.81). Of these, 15 (26.8%) patients underwent surgery, and 25 (44.6%) patients had a prolonged hospital stay. One patient (1.8%) died after perforation from a diagnostic colonoscopy. In the multivariate analysis, diagnostic colonoscopy (adjusted odds ratio [aOR] 196.43,
p
= 0.025) and abdominal rebound tenderness (aOR 17.82,
p
= 0.012) were independent risk factors for surgical treatment. The location of the sigmoid colon (aOR 18.57,
p
= 0.048), delayed recognition (aOR 187.71,
p
= 0.008), and abdominal tenderness (aOR 63.20,
p
= 0.017) were independent risk factors for prolonged hospitalization.
Conclusions
This prospective study demonstrated that the incidence of colonoscopy-related perforation was 0.66/1000. The incidence rate was higher in therapeutic colonoscopy, whereas the risk for undergoing surgery was higher in patients undergoing diagnostic colonoscopy. Colonoscopy indication (diagnostic vs. therapeutic), physical signs, the location of the sigmoid perforation, and delayed recognition were independent risk factors for poor clinical outcomes in colonoscopy-related perforation.
Graphical abstract |
| doi_str_mv | 10.1007/s00464-023-10046-5 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2802885771</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2802885771</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-d88a411b90fcfeda7452cffb375323a5a54987c8ebc6b77a151c62e6ef80b28e3</originalsourceid><addsrcrecordid>eNp9kU1vFSEYhYnR2Gv1D7gwJG5qIsrHMDDdmcaPJk3c6JowzEulzsAITM39I_5eud6qiQs3QHKe97yHHISeMvqKUapeF0q7viOUC8IOTyLvoR3rBCecM30f7eggKOFq6E7Qo1JuaIMGJh-iE6FoP3SC7tCPy-jCBNEBTh67NKeYikvrnmSYbYUJr5B9yraGFLGNE86hfMXeuppywU3Ba2pH2qpLC5RzLMgebMYZyjbXRuS0YIvXnMoKroZbeImXpgQHscKBuw6l5j0--x7qF3zbwqTy4jF64O1c4MndfYo-v3v76eIDufr4_vLizRVxQslKJq1tx9g4UO88TFZ1kjvvxyYKLqy0shu0chpG149KWSaZ6zn04DUduQZxis6Ovi3ftw1KNUsoDubZRkhbMVxTrrVUijX0-T_oTdpybOkaJXrGBNOyUfxIufbhksGbNYfF5r1h1BxaM8fWTGvN_GrNHIae3Vlv4wLTn5HfNTVAHIHSpHgN-e_u_9j-BEvIpVM</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2836113185</pqid></control><display><type>article</type><title>Incidence of colonoscopy-related perforation and risk factors for poor outcomes: 3-year results from a prospective, multicenter registry (with videos)</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Lee, Jieun ; Lee, Yoo Jin ; Seo, Jong Won ; Kim, Eun Soo ; Kim, Sung Kook ; Jung, Min Kyu ; Heo, Jun ; Lee, Hyun Seok ; Lee, Joon Seop ; Jang, Byung Ik ; Kim, Kyeong Ok ; Cho, Kwang Bum ; Kim, Eun Young ; Kim, Dae Jin ; Chung, Yun Jin</creator><creatorcontrib>Lee, Jieun ; Lee, Yoo Jin ; Seo, Jong Won ; Kim, Eun Soo ; Kim, Sung Kook ; Jung, Min Kyu ; Heo, Jun ; Lee, Hyun Seok ; Lee, Joon Seop ; Jang, Byung Ik ; Kim, Kyeong Ok ; Cho, Kwang Bum ; Kim, Eun Young ; Kim, Dae Jin ; Chung, Yun Jin ; Daegu-Gyeongbuk Gastrointestinal Study Group ; On behalf of Daegu-Gyeongbuk Gastrointestinal Study Group</creatorcontrib><description>Background and aims
Perforation is a life-threatening adverse event of colonoscopy that often requires hospitalization and surgery. We aimed to prospectively assess the incidence of colonoscopy-related perforation in a multicenter registry and to analyze the clinical factors associated with poor clinical outcomes.
Methods
This prospective observational study was conducted at six tertiary referral hospitals between 2017 and 2020, and included patients with colonic perforation after colonoscopy. Poor clinical outcomes were defined as mortality, surgery, and prolonged hospitalization (> 13 days). Logistic regression was used to identify factors associated with poor clinical outcomes.
Results
Among 84,673 patients undergoing colonoscopy, 56 had colon perforation (0.66/1000, 95% confidence interval [CI] 0.51–0.86). Perforation occurred in 12 of 63,602 diagnostic colonoscopies (0.19/1000, 95% CI 0.11–0.33) and 44 of 21,071 therapeutic colonoscopies (2.09/1000, 95% CI 1.55–2.81). Of these, 15 (26.8%) patients underwent surgery, and 25 (44.6%) patients had a prolonged hospital stay. One patient (1.8%) died after perforation from a diagnostic colonoscopy. In the multivariate analysis, diagnostic colonoscopy (adjusted odds ratio [aOR] 196.43,
p
= 0.025) and abdominal rebound tenderness (aOR 17.82,
p
= 0.012) were independent risk factors for surgical treatment. The location of the sigmoid colon (aOR 18.57,
p
= 0.048), delayed recognition (aOR 187.71,
p
= 0.008), and abdominal tenderness (aOR 63.20,
p
= 0.017) were independent risk factors for prolonged hospitalization.
Conclusions
This prospective study demonstrated that the incidence of colonoscopy-related perforation was 0.66/1000. The incidence rate was higher in therapeutic colonoscopy, whereas the risk for undergoing surgery was higher in patients undergoing diagnostic colonoscopy. Colonoscopy indication (diagnostic vs. therapeutic), physical signs, the location of the sigmoid perforation, and delayed recognition were independent risk factors for poor clinical outcomes in colonoscopy-related perforation.
Graphical abstract</description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-023-10046-5</identifier><identifier>PMID: 37069430</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Abdominal Surgery ; Colonic Diseases - epidemiology ; Colonic Diseases - etiology ; Colonic Diseases - surgery ; Colonoscopy ; Colonoscopy - adverse effects ; Gastroenterology ; Gynecology ; Health risks ; Hepatology ; Hospitalization ; Humans ; Incidence ; Intestinal Perforation - epidemiology ; Intestinal Perforation - etiology ; Intestinal Perforation - surgery ; Medicine ; Medicine & Public Health ; Proctology ; Prospective Studies ; Registries ; Retrospective Studies ; Risk Factors ; Surgery ; Surgical outcomes</subject><ispartof>Surgical endoscopy, 2023-08, Vol.37 (8), p.5865-5874</ispartof><rights>The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-d88a411b90fcfeda7452cffb375323a5a54987c8ebc6b77a151c62e6ef80b28e3</citedby><cites>FETCH-LOGICAL-c375t-d88a411b90fcfeda7452cffb375323a5a54987c8ebc6b77a151c62e6ef80b28e3</cites><orcidid>0000-0003-0806-9136</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-023-10046-5$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-023-10046-5$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37069430$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lee, Jieun</creatorcontrib><creatorcontrib>Lee, Yoo Jin</creatorcontrib><creatorcontrib>Seo, Jong Won</creatorcontrib><creatorcontrib>Kim, Eun Soo</creatorcontrib><creatorcontrib>Kim, Sung Kook</creatorcontrib><creatorcontrib>Jung, Min Kyu</creatorcontrib><creatorcontrib>Heo, Jun</creatorcontrib><creatorcontrib>Lee, Hyun Seok</creatorcontrib><creatorcontrib>Lee, Joon Seop</creatorcontrib><creatorcontrib>Jang, Byung Ik</creatorcontrib><creatorcontrib>Kim, Kyeong Ok</creatorcontrib><creatorcontrib>Cho, Kwang Bum</creatorcontrib><creatorcontrib>Kim, Eun Young</creatorcontrib><creatorcontrib>Kim, Dae Jin</creatorcontrib><creatorcontrib>Chung, Yun Jin</creatorcontrib><creatorcontrib>Daegu-Gyeongbuk Gastrointestinal Study Group</creatorcontrib><creatorcontrib>On behalf of Daegu-Gyeongbuk Gastrointestinal Study Group</creatorcontrib><title>Incidence of colonoscopy-related perforation and risk factors for poor outcomes: 3-year results from a prospective, multicenter registry (with videos)</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><addtitle>Surg Endosc</addtitle><description>Background and aims
Perforation is a life-threatening adverse event of colonoscopy that often requires hospitalization and surgery. We aimed to prospectively assess the incidence of colonoscopy-related perforation in a multicenter registry and to analyze the clinical factors associated with poor clinical outcomes.
Methods
This prospective observational study was conducted at six tertiary referral hospitals between 2017 and 2020, and included patients with colonic perforation after colonoscopy. Poor clinical outcomes were defined as mortality, surgery, and prolonged hospitalization (> 13 days). Logistic regression was used to identify factors associated with poor clinical outcomes.
Results
Among 84,673 patients undergoing colonoscopy, 56 had colon perforation (0.66/1000, 95% confidence interval [CI] 0.51–0.86). Perforation occurred in 12 of 63,602 diagnostic colonoscopies (0.19/1000, 95% CI 0.11–0.33) and 44 of 21,071 therapeutic colonoscopies (2.09/1000, 95% CI 1.55–2.81). Of these, 15 (26.8%) patients underwent surgery, and 25 (44.6%) patients had a prolonged hospital stay. One patient (1.8%) died after perforation from a diagnostic colonoscopy. In the multivariate analysis, diagnostic colonoscopy (adjusted odds ratio [aOR] 196.43,
p
= 0.025) and abdominal rebound tenderness (aOR 17.82,
p
= 0.012) were independent risk factors for surgical treatment. The location of the sigmoid colon (aOR 18.57,
p
= 0.048), delayed recognition (aOR 187.71,
p
= 0.008), and abdominal tenderness (aOR 63.20,
p
= 0.017) were independent risk factors for prolonged hospitalization.
Conclusions
This prospective study demonstrated that the incidence of colonoscopy-related perforation was 0.66/1000. The incidence rate was higher in therapeutic colonoscopy, whereas the risk for undergoing surgery was higher in patients undergoing diagnostic colonoscopy. Colonoscopy indication (diagnostic vs. therapeutic), physical signs, the location of the sigmoid perforation, and delayed recognition were independent risk factors for poor clinical outcomes in colonoscopy-related perforation.
Graphical abstract</description><subject>Abdominal Surgery</subject><subject>Colonic Diseases - epidemiology</subject><subject>Colonic Diseases - etiology</subject><subject>Colonic Diseases - surgery</subject><subject>Colonoscopy</subject><subject>Colonoscopy - adverse effects</subject><subject>Gastroenterology</subject><subject>Gynecology</subject><subject>Health risks</subject><subject>Hepatology</subject><subject>Hospitalization</subject><subject>Humans</subject><subject>Incidence</subject><subject>Intestinal Perforation - epidemiology</subject><subject>Intestinal Perforation - etiology</subject><subject>Intestinal Perforation - surgery</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Proctology</subject><subject>Prospective Studies</subject><subject>Registries</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Surgery</subject><subject>Surgical outcomes</subject><issn>0930-2794</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp9kU1vFSEYhYnR2Gv1D7gwJG5qIsrHMDDdmcaPJk3c6JowzEulzsAITM39I_5eud6qiQs3QHKe97yHHISeMvqKUapeF0q7viOUC8IOTyLvoR3rBCecM30f7eggKOFq6E7Qo1JuaIMGJh-iE6FoP3SC7tCPy-jCBNEBTh67NKeYikvrnmSYbYUJr5B9yraGFLGNE86hfMXeuppywU3Ba2pH2qpLC5RzLMgebMYZyjbXRuS0YIvXnMoKroZbeImXpgQHscKBuw6l5j0--x7qF3zbwqTy4jF64O1c4MndfYo-v3v76eIDufr4_vLizRVxQslKJq1tx9g4UO88TFZ1kjvvxyYKLqy0shu0chpG149KWSaZ6zn04DUduQZxis6Ovi3ftw1KNUsoDubZRkhbMVxTrrVUijX0-T_oTdpybOkaJXrGBNOyUfxIufbhksGbNYfF5r1h1BxaM8fWTGvN_GrNHIae3Vlv4wLTn5HfNTVAHIHSpHgN-e_u_9j-BEvIpVM</recordid><startdate>20230801</startdate><enddate>20230801</enddate><creator>Lee, Jieun</creator><creator>Lee, Yoo Jin</creator><creator>Seo, Jong Won</creator><creator>Kim, Eun Soo</creator><creator>Kim, Sung Kook</creator><creator>Jung, Min Kyu</creator><creator>Heo, Jun</creator><creator>Lee, Hyun Seok</creator><creator>Lee, Joon Seop</creator><creator>Jang, Byung Ik</creator><creator>Kim, Kyeong Ok</creator><creator>Cho, Kwang Bum</creator><creator>Kim, Eun Young</creator><creator>Kim, Dae Jin</creator><creator>Chung, Yun Jin</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-0806-9136</orcidid></search><sort><creationdate>20230801</creationdate><title>Incidence of colonoscopy-related perforation and risk factors for poor outcomes: 3-year results from a prospective, multicenter registry (with videos)</title><author>Lee, Jieun ; Lee, Yoo Jin ; Seo, Jong Won ; Kim, Eun Soo ; Kim, Sung Kook ; Jung, Min Kyu ; Heo, Jun ; Lee, Hyun Seok ; Lee, Joon Seop ; Jang, Byung Ik ; Kim, Kyeong Ok ; Cho, Kwang Bum ; Kim, Eun Young ; Kim, Dae Jin ; Chung, Yun Jin</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-d88a411b90fcfeda7452cffb375323a5a54987c8ebc6b77a151c62e6ef80b28e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Abdominal Surgery</topic><topic>Colonic Diseases - epidemiology</topic><topic>Colonic Diseases - etiology</topic><topic>Colonic Diseases - surgery</topic><topic>Colonoscopy</topic><topic>Colonoscopy - adverse effects</topic><topic>Gastroenterology</topic><topic>Gynecology</topic><topic>Health risks</topic><topic>Hepatology</topic><topic>Hospitalization</topic><topic>Humans</topic><topic>Incidence</topic><topic>Intestinal Perforation - epidemiology</topic><topic>Intestinal Perforation - etiology</topic><topic>Intestinal Perforation - surgery</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Proctology</topic><topic>Prospective Studies</topic><topic>Registries</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Surgery</topic><topic>Surgical outcomes</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lee, Jieun</creatorcontrib><creatorcontrib>Lee, Yoo Jin</creatorcontrib><creatorcontrib>Seo, Jong Won</creatorcontrib><creatorcontrib>Kim, Eun Soo</creatorcontrib><creatorcontrib>Kim, Sung Kook</creatorcontrib><creatorcontrib>Jung, Min Kyu</creatorcontrib><creatorcontrib>Heo, Jun</creatorcontrib><creatorcontrib>Lee, Hyun Seok</creatorcontrib><creatorcontrib>Lee, Joon Seop</creatorcontrib><creatorcontrib>Jang, Byung Ik</creatorcontrib><creatorcontrib>Kim, Kyeong Ok</creatorcontrib><creatorcontrib>Cho, Kwang Bum</creatorcontrib><creatorcontrib>Kim, Eun Young</creatorcontrib><creatorcontrib>Kim, Dae Jin</creatorcontrib><creatorcontrib>Chung, Yun Jin</creatorcontrib><creatorcontrib>Daegu-Gyeongbuk Gastrointestinal Study Group</creatorcontrib><creatorcontrib>On behalf of Daegu-Gyeongbuk Gastrointestinal Study Group</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lee, Jieun</au><au>Lee, Yoo Jin</au><au>Seo, Jong Won</au><au>Kim, Eun Soo</au><au>Kim, Sung Kook</au><au>Jung, Min Kyu</au><au>Heo, Jun</au><au>Lee, Hyun Seok</au><au>Lee, Joon Seop</au><au>Jang, Byung Ik</au><au>Kim, Kyeong Ok</au><au>Cho, Kwang Bum</au><au>Kim, Eun Young</au><au>Kim, Dae Jin</au><au>Chung, Yun Jin</au><aucorp>Daegu-Gyeongbuk Gastrointestinal Study Group</aucorp><aucorp>On behalf of Daegu-Gyeongbuk Gastrointestinal Study Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Incidence of colonoscopy-related perforation and risk factors for poor outcomes: 3-year results from a prospective, multicenter registry (with videos)</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><addtitle>Surg Endosc</addtitle><date>2023-08-01</date><risdate>2023</risdate><volume>37</volume><issue>8</issue><spage>5865</spage><epage>5874</epage><pages>5865-5874</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><abstract>Background and aims
Perforation is a life-threatening adverse event of colonoscopy that often requires hospitalization and surgery. We aimed to prospectively assess the incidence of colonoscopy-related perforation in a multicenter registry and to analyze the clinical factors associated with poor clinical outcomes.
Methods
This prospective observational study was conducted at six tertiary referral hospitals between 2017 and 2020, and included patients with colonic perforation after colonoscopy. Poor clinical outcomes were defined as mortality, surgery, and prolonged hospitalization (> 13 days). Logistic regression was used to identify factors associated with poor clinical outcomes.
Results
Among 84,673 patients undergoing colonoscopy, 56 had colon perforation (0.66/1000, 95% confidence interval [CI] 0.51–0.86). Perforation occurred in 12 of 63,602 diagnostic colonoscopies (0.19/1000, 95% CI 0.11–0.33) and 44 of 21,071 therapeutic colonoscopies (2.09/1000, 95% CI 1.55–2.81). Of these, 15 (26.8%) patients underwent surgery, and 25 (44.6%) patients had a prolonged hospital stay. One patient (1.8%) died after perforation from a diagnostic colonoscopy. In the multivariate analysis, diagnostic colonoscopy (adjusted odds ratio [aOR] 196.43,
p
= 0.025) and abdominal rebound tenderness (aOR 17.82,
p
= 0.012) were independent risk factors for surgical treatment. The location of the sigmoid colon (aOR 18.57,
p
= 0.048), delayed recognition (aOR 187.71,
p
= 0.008), and abdominal tenderness (aOR 63.20,
p
= 0.017) were independent risk factors for prolonged hospitalization.
Conclusions
This prospective study demonstrated that the incidence of colonoscopy-related perforation was 0.66/1000. The incidence rate was higher in therapeutic colonoscopy, whereas the risk for undergoing surgery was higher in patients undergoing diagnostic colonoscopy. Colonoscopy indication (diagnostic vs. therapeutic), physical signs, the location of the sigmoid perforation, and delayed recognition were independent risk factors for poor clinical outcomes in colonoscopy-related perforation.
Graphical abstract</abstract><cop>New York</cop><pub>Springer US</pub><pmid>37069430</pmid><doi>10.1007/s00464-023-10046-5</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0003-0806-9136</orcidid></addata></record> |
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| ispartof | Surgical endoscopy, 2023-08, Vol.37 (8), p.5865-5874 |
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| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | Abdominal Surgery Colonic Diseases - epidemiology Colonic Diseases - etiology Colonic Diseases - surgery Colonoscopy Colonoscopy - adverse effects Gastroenterology Gynecology Health risks Hepatology Hospitalization Humans Incidence Intestinal Perforation - epidemiology Intestinal Perforation - etiology Intestinal Perforation - surgery Medicine Medicine & Public Health Proctology Prospective Studies Registries Retrospective Studies Risk Factors Surgery Surgical outcomes |
| title | Incidence of colonoscopy-related perforation and risk factors for poor outcomes: 3-year results from a prospective, multicenter registry (with videos) |
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