Shin Seung Yong, Cho Min Soo, Nam Jinhoon, Kim Jie-Hyun, Yoon Young Hoon, Park Hyojin, Kang Jeonghyun, Park Jae Jun
Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Department of Internal Medicine, Chung-Ang University, College of Medicine, Seoul, Korea.
Ther Adv Gastrointest Endosc. 2025 Jan 9;18:26317745241312521. doi: 10.1177/26317745241312521. eCollection 2025 Jan-Dec.
Colonoscopic polypectomy significantly reduces the incidence of colorectal cancer, but it carries potential risks, with colonic perforation being the most common and associated with significant morbidity.
This study evaluated the clinical outcomes and risk factors of microperforation during colonoscopic polypectomy.
A retrospective cohort study.
We retrospectively reviewed the patients' records who underwent colonoscopic polypectomy and subsequent plain radiographic examination to monitor perforation. Patients with pneumoperitoneum detected on plain radiography were enrolled. Patients who underwent adverse event-free colonoscopic polypectomies within 1 week of each case and were matched 2:1 by age and sex to the cases were selected as controls.
Microperforations occurred in 12 patients (8 males; age: median 64.5 years). Polyps with microperforations were more frequent in the right colon (83.3% vs 33.3%). Endoscopic mucosal resection with precutting (EMR-P; 16.7% vs 0.0%) or hot-snare polypectomy (8.3% vs 0.0%) was more frequently performed in the microperforation group. Muscle fibers at the polypectomy site were more frequently visible in the microperforation group (58.3% vs 8.3%). By multivariate analysis, right colon location and visible muscle fibers were independent risk factors for microperforation. All patients with microperforation received intravenous antibiotics and were advised to fast. Patients responded well to these conservative treatments and were discharged after a median of 3 (2-6.75) days of hospital stay.
Our data suggest that conservative treatment is feasible and could be the primary management option for selected patients with microperforations postcolonoscopic polypectomy. Right-sided colonic polyps and visible muscle fibers predispose to microperforations.
结肠镜下息肉切除术可显著降低结直肠癌的发病率，但该手术存在潜在风险，其中结肠穿孔最为常见且与严重的发病情况相关。
本研究评估结肠镜下息肉切除术期间微小穿孔的临床结局及危险因素。
一项回顾性队列研究。
我们回顾性分析了接受结肠镜下息肉切除术及随后的腹部平片检查以监测穿孔情况的患者记录。纳入腹部平片检查发现有气腹的患者。选取在每例病例的1周内接受了无不良事件的结肠镜下息肉切除术且年龄和性别按2:1与病例匹配的患者作为对照。
12例患者（8例男性；年龄中位数64.5岁）发生微小穿孔。发生微小穿孔的息肉在右半结肠更为常见（83.3%对33.3%）。微小穿孔组更常采用内镜下预切开黏膜切除术（EMR-P；16.7%对0.0%）或热圈套息肉切除术（8.3%对0.0%）。微小穿孔组息肉切除部位的肌纤维更常可见（58.3%对8.3%）。多因素分析显示，右半结肠位置和可见肌纤维是微小穿孔的独立危险因素。所有发生微小穿孔的患者均接受了静脉抗生素治疗并被建议禁食。患者对这些保守治疗反应良好，中位住院3（2 - 6.75）天后出院。
我们的数据表明，保守治疗是可行的，对于结肠镜下息肉切除术后发生微小穿孔的部分患者可能是主要的治疗选择。右侧结肠息肉和可见肌纤维易导致微小穿孔。
