Clinical outcomes and direct costings of endoluminal clipping compared to surgery in the management of iatrogenic colonic perforation.

ObjectiveTo compare the outcomes and costs of endoluminal clipping and surgery in the management of iatrogenic colonic perforation. MethodsA retrospective, single-center, clinical and economic analysis of outcomes and costings between endoluminal clipping and surgery in consecutive cases of iatrogenic colonic perforations was conducted. ResultsIn total, 7136 colonoscopies performed over a 6-year period were complicated by 12 (0.17%) perforations. Seven cases were treated by endoscopic clipping (with a success rate of 71.4%) and five with immediate surgery. Both groups of patients had similar clinical and individual characteristics. Patients who were treated with endoscopic clipping had a shorter period of hospitalization (median 9 vs 13 days) compared to surgery, but this was not statistically significant. Compared to patients who had immediate surgery, the median direct health-care costs for all procedures (US$ 115.10 vsUS$ 1479.50, P=0.012) and investigations (US$ 124.60 vsUS$ 512.90, P=0.048) during inpatient stay were lower for the endoscopic clipping group. There was a trend towards a lower overall inpatient median cost for patients managed with endoscopic clipping compared to surgery (US$ 1481.70 vsUS$ 3281.90, P=0.073). ConclusionEndoluminal clipping may be more cost-effective than surgery in the management of iatrogenic colonic perforations.