Non-operative management in patients with iatrogenic colorectal perforations: protocol for a systematic review

Iatrogenic colorectal perforation (ICP) is a rare but serious complication of diagnostic and therapeutic colonoscopies, associated with significant morbidity and mortality. While surgical intervention remains common, non-operative management (NOM) has emerged as a potential alternative for select patients. However, high-level evidence on the safety and effectiveness of NOM remains limited. Randomized controlled trials (RCTs), case-control studies, cohort studies, and observational studies comparing surgical treatment with NOM in patients aged ≥18 years old with ICP will be included. Only studies published in English and Russian will be included. Exclusion criteria include studies of non-iatrogenic colorectal perforations, studies without an active comparator group, studies lacking appropriate statistical analysis, case reports, and case series. Primary endoscopic closure performed immediately upon detection during colonoscopy is considered part of NOM, not surgical treatment. The primary outcome is the clinical success of NOM, defined as successful non-operative management during index hospitalization and within 30-day follow-up, characterized by absence of need for surgical intervention and clinical resolution of symptoms. Secondary outcomes include length of hospital stay, 30-day mortality, and complication rates. We will conduct a comprehensive literature search up to July 2026 across five major databases (PubMed, Scopus, Web of Science, eLibrary, Cochrane Central). The methodology will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses—Protocols (PRISMA-P) guidelines. Ethics approval is not required for this review. We will share our findings through peer-reviewed publications and academic presentations with the scientific community. This review will synthesize comparative evidence on NOM for ICP and thereby improve existing guidelines. It may highlight scenarios where NOM can safely avoid the need for surgical interventions, improving clinical decision-making. PROSPERO CRD420251003788.