Management of delayed colonic perforation after endoscopic submucosal dissection: the over-the-scope clip way

Delayed perforation is a rare and serious adverse event after endoscopic submucosal dissection (ESD), developing within 48 hours after the procedure without any signs of perforation or muscle injury during ESD.1 Delayed perforation after colonic ESD is often more serious than gastric ESD because of high chance of peritonitis as the result of seepage of digestive enzymes and bacteria-rich colonic fluid.2 Endoscopy for delayed perforations can be dangerous because of the risk of barotrauma and further aggravation of the perforation.