BACKGROUND AND AIMS:
Perforation during colonoscopy remains the most worrisome adverse event, and usually requires urgent surgical rescue. Study aim was to evaluate the feasibility and effectiveness of endoscopic closure of full-thickness colonic perforations.
We performed retrospective analysis of all consecutive patients with endoscopically closed colonic perforations over the last 6 years (2009-2014). Colonic perforations were closed using endoscopic clips or endoscopic suturing device. Most patients were admitted for intravenous antibiotics and kept on bowel rest. If their clinical condition deteriorated, urgent surgery was performed. If patients remained stable, oral feeding was resumed and patients were discharged with subsequent clinical and endoscopic follow-up.
21 patients had iatrogenic colonic perforations closed with endoscopic suturing device or endoscopic clips over the study period. Primary closure of colonic perforation was performed with endoscopic clips in 5 patients and sutured with endoscopic suturing device in 16 patients. All 5 patients after clips closure had worsening of abdominal pain and required laparoscopy (4 patients) or rescue colonoscopy with endoscopic suturing closure (1 patient). Two patients had abdominal pain after endoscopic suturing closure, but diagnostic laparoscopy confirmed complete and adequate endoscopic closure of the perforations. The other 15 patients did not require any rescue surgery or laparoscopy after endoscopic suturing. The main limitation of our study is its retrospective, single center design and relatively small number of patients.
Endoscopic suturing closure of colonic perforations is technically feasible, eliminates the need for rescue surgery and appears more effective than closure with hemostatic endoscopic clips.