| Theme | To prevent from complication in colonoscopy | |
|---|---|---|
| Title | Complications of endoscopic treatment -- Perforations during therapeutic colonoscopy | |
| Publish Date | 2002/03 | |
| Author | Hironori Yamamoto | Division of Castroenterology, Department of Internal Medicine, Jichi Medical School |
| [ Summary ] | The rate of perforation associated with colonoscopy is reported to be as low as 0.05%. The rate for therapeutic colonoscopy is higher, with a rate of about 0.1%. In order to avoid grave complications such as perforations, all preventive techniques should be employed. For prevention of these complications, technical improvement and appropriate selection of cases for endoscopic treatment are essential. Practical instructions for prevention of perforations in endoscopic mucosal resection include; maintaining a satisfactory view during the procedure, i. e. positioning the lesions in the direction of the accessory channel, appropriately sufficient local injections of normal saline, in order to produce an adequate protrusion in the affected mucosa, snaring the protruded mucosa around the middle while avoiding the base of the protrusion, loosening the snare with air inflation to avoid muscle involvement before the final stage of snaring, appropriate application of electrocautization to prevent over coagulation. Once perforations occur, careful judgement for proper management is necessary. In general, perforations during diagnostic colonoscopy result in large injuries, which require surgical treatment. However, perforations during therapeutic colonoscopy are usually small and their locations are clearly recognized. Therefore, those in the latter case may be managed nonoperatively with clip placement, as long as signs of diffuse peritonitis are not observed. |
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