FP2.9 - Colonoscopy perforation: a single centre study

Abstract Aim Colonoscopy is increasing utilized as a diagnostic & therapeutic tool. Colonoscopy perforation is reported to occur in 1/1500 (diagnostic colonoscopy), 1/500 (polypectomy) & 1/50 (EMR) procedures. The aim of the study is to evaluate the management of colonoscopy perforation at a single centre. Methods Colonoscopy is carried out on patients with colorectal cancer trigger symptoms (altered bowel habit, rectal bleeding, weight loss, abdominal pain, anaemia, ano-rectal symptoms, etc), family history screening, colorectal cancer & polyp surveillance. This is cohort study carried out since 2012 to December 2023 on all colonoscopy perforations carried out at a single centre. Results N = 22 Age (yrs) 70.8 ± 3.4 Sex (M:F) 4 : 18 BMI (kg/m2) 25.3 ± 1.8 ASA 2 Sigmoid Perf site (n) 13 LOS (days) 6 ± 6.5 Deaths (n) 30 day 3 60 day 3 90 day 3 IBD (n) 3 DD (n) 11 WCC (x109/L) 11.3 ± 1.4 CRP (mg/L) 100.1 ± 25.7 Lactate (mmol/L) 1.3 ± 0.7 Op time (mins) 119.0 ± 15.3 Bx 6 Polypectomy 5 Colonoscopy 21 (9 incomplete) Flexi siggy 1 Sedation 16 Entonox 5 GA 1 Xray 10 CT scan 22 Conservative 9 Surgery 13 Stoma (n) 6 Lap 2 Lap open 2 Open 9 Conclusion Colonic perforation during colonoscopy is increased in: polypectomy (especially right colonic), therapeutic EMR, diseased bowel (IBD inflammatory bowel disease, diverticular disease), & in challenging colons. The management of colonoscopy perforation should individualized with early clinical & radiological diagnosis. Site and size of colonic perforation determines management. Good bowel preparations, minimizes contamination and therefore allows safe conservative management of small colonoscopy perforation.