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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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Author(s)
Jieun LeeYoo Jin LeeJong Won SeoEun Soo KimSung Kook KimMin Kyu JungJun HeoHyun Seok LeeJoon Seop LeeByung Ik JangKyeong Ok KimKwang Bum ChoEun Young KimDae Jin KimYun Jin Chung
Keimyung Author(s)
Lee, Yoo JinCho, Kwang Bum
Department
Dept. of Internal Medicine (내과학)
Journal Title
Surg Endosc
Issued Date
2023
Volume
37
Issue
8
Keyword
ColonoscopyIncidencePerforationRisk factor
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.
Keimyung Author(s)(Kor)
이유진
조광범
Publisher
School of Medicine (의과대학)
Type
Article
ISSN
1432-2218
Source
https://link.springer.com/article/10.1007/s00464-023-10046-5
DOI
10.1007/s00464-023-10046-5
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/45028
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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