Adebisi Ajibola A, Onobun Daniel E, Adediran Adeola, Ononye Reginald N, Ojo Ethel O, Oluyi Adedayo, Ojo Ayotunde, Oputa Stephen
General Surgery, Epsom and St Helier University NHS Foundation Trust, London, GBR.
Orthopaedics and Trauma, Warwick Hospital, South Warwickshire University NHS Foundation Trust, Warwick, GBR.
Cureus. 2024 Nov 8;16(11):e73302. doi: 10.7759/cureus.73302. eCollection 2024 Nov.
This systematic review and meta-analysis explores the clinical and patient-specific factors contributing to increased morbidity and mortality following iatrogenic colonic perforation (ICP) during routine colonoscopy. A comprehensive search of Scopus, PubMed (Medline), Embase, and Google Scholar was conducted, reviewing studies published between 2010 and 2024. Data were synthesized through thematic analysis for qualitative data and meta-analysis for quantitative outcomes. This study found the overall perforation rate during colonoscopy to be between 0.019% and 0.66%. The average age of patients was 68.91 years. The mortality rate was approximately 11%. Older patients had a higher risk of perforation and an increased mortality rate. Therapeutic colonoscopy carries a significantly higher risk of perforation compared to diagnostic colonoscopy. Diagnostic colonoscopies were more likely to cause larger perforations, which, in turn, carry greater morbidity than smaller perforations. The most common sites of perforation are the sigmoid colon and the rectosigmoid junction. The leading causes of perforation include diverticulitis, malignancy, abnormal sigmoid anatomy, and inflammatory bowel disease. About half of the perforations were discovered during or immediately after the procedure. The most common surgical interventions were resection with primary anastomosis and Hartmann's procedure. Operators with limited experience were more likely to cause perforations and experience delayed recognition of the issue. The results suggest that both clinical and patient-specific factors play critical roles in determining outcomes for patients experiencing ICP during routine colonoscopy. Early detection, timely intervention, and operator experience are key to improving patient survival and reducing complications. Furthermore, the study highlights the need for ongoing research to refine patient selection criteria and enhance postoperative care protocols, particularly for high-risk populations such as the elderly and those with significant comorbidities. This review underscores the importance of heightened vigilance in colonoscopy procedures, especially among vulnerable populations. Future research should focus on improving diagnostic protocols and treatment strategies to minimize the risks associated with ICP and enhance patient safety in routine colonoscopy practices.
本系统评价和荟萃分析探讨了在常规结肠镜检查期间导致医源性结肠穿孔（ICP）后发病率和死亡率增加的临床及患者特异性因素。对Scopus、PubMed（Medline）、Embase和谷歌学术进行了全面检索，回顾了2010年至2024年发表的研究。通过主题分析对定性数据进行综合，并对定量结果进行荟萃分析。本研究发现结肠镜检查期间的总体穿孔率在0.019%至0.66%之间。患者的平均年龄为68.91岁。死亡率约为11%。老年患者穿孔风险更高，死亡率也更高。与诊断性结肠镜检查相比，治疗性结肠镜检查的穿孔风险显著更高。诊断性结肠镜检查更有可能导致较大的穿孔，而较大穿孔的发病率高于较小穿孔。最常见的穿孔部位是乙状结肠和直肠乙状结肠交界处。穿孔的主要原因包括憩室炎、恶性肿瘤、乙状结肠解剖异常和炎症性肠病。约一半的穿孔在手术期间或手术后立即被发现。最常见的手术干预是一期吻合切除术和哈特曼手术。经验有限的操作人员更有可能导致穿孔并延迟对问题的识别。结果表明，临床和患者特异性因素在决定常规结肠镜检查期间发生ICP的患者的预后方面都起着关键作用。早期检测、及时干预和操作人员经验是提高患者生存率和减少并发症的关键。此外，该研究强调需要持续开展研究，以完善患者选择标准并加强术后护理方案，特别是针对老年人和患有严重合并症等高危人群。本综述强调了在结肠镜检查过程中提高警惕的重要性，尤其是在弱势群体中。未来的研究应侧重于改进诊断方案和治疗策略，以将与ICP相关的风险降至最低，并提高常规结肠镜检查实践中的患者安全性。
