Colonoscopic Perforation Incidence and Risk Factors in Rajavithi Training Hospital

Abstract

Background: The colonoscope has become a standard tool for diagnosing and treating pathological diseases of the colon. Colonoscopic perforation is one of the serious consequences associated with colonoscopy, and as a result, it may result in a high rate of morbidity and mortality.

Objectives: This study aims to determine the incidence and risk factors associated with colonoscopic perforation in a training institution.

Methods: A retrospective review of medical records was performed for patients undergoing colonoscopy in Rajavithi Hospital between 2009 and 2019, total 10.057 patient. The patient’s demographic data, indication for colonoscopy, quality of bowel preparation, endoscopic procedure, perforation, and diagnostic were recorded.

Results: Between 2009 and 2019 12,239 colonoscope was performed and 2,182 colonoscopy was excluded. In total 0.71% (71/10,057) colonoscopic perforation was occurred. Multivariate logistic regression analysis reveals that previous gynecologic surgery (OR 41.1, p-value < 0.001, 95% CI 16.40-102.73), general anesthesia (OR 7.74, p-value 0.016, 95% CI 1.46-40.97), trainee (OR 20.74, p-value < 0.001, 95% CI 11.25-38.35) and polypectomy (OR 6.08, p-value < 0.001, 95% CI 3.15-11.70), EMR (OR 23.32, p-value < 0.001, 95% CI 6.02-90.41) and endoscopic subepithelial dissection (OR 89.99, p-value < 0.001, 95% CI 12.74-135.46) were significant.

Conclusion: Patients tend to have a higher colonoscopic perforation rate when they have a history of previous gynecological surgery or general anesthesia the colonoscopy to be performed by a trainee or polypectomy or endoscopic submucosal resection (EMR) or endoscopic submucosal dissection (ESD) to be performed. Even though we're aware of the risk factor, we must nevertheless handle each case with care and solely focus on high-risk populations in our practice.