Sa1720 Predictive Factors for Better Outcomes in Colonoscopy-Associated Perforation

Colonoscopy has been widely used for diagnostic and therapeutic purposes. Although the incidence is very low, perforation is one of the most serious complication. It is important to decide whether to try endoscopic clipping or to perform prompt surgical management. Methods and results: We retrospectively reviewed charts of all patients who experienced colonoscopy-associated perforation in a single center between May 2009 and July 2015, and totally 45 patients were enrolled (Figure 1). Diagnostic cases in purpose, sigmoid colon in location and non-clipping status were significantly more common in surgery group than conservative group (Table 1). Endoscopic clipping was performed in 31 cases (immediate; 23, delayed; 8), and immediate clipping group had significantly lower rate of operation (p=0.013) and better clinical outcome (duration of antibiotics : p=0.006, hospital stay : p=0.001). Among 18 surgical cases, 13 patients had primary closure and 5 patients had complex surgery (2; segmental resection, 3; Hartmann’s procedure). The early (< 24hr) surgical management significantly decreased the possibility of complex surgery (p=0.002) (Table 2), as well as had better clinical outcomes such as duration of antibiotic use, fasting time and length of hospital stay (p=0.003, p=0.001, p=0.005, respectively). In therapeutic cases, all five perforated patients who had surgery within 1 day could be managed by simple primary closure, but all four patients who had surgery after 1 day required complex surgery (Figure 1).