Methods: We conducted a retrospective review of the medical records of all the patients who underwent colonoscopy complicated by colon perforation between January 2004 and December 2007. The patients' demographics, the purpose of colonoscopy, the location of the perforation, the management and the outcome were compared.

Results: A total of 5254 patients underwent either a diagnostic or therapeutic colonoscopy procedure during four consecutive years at a single institution. Iatrogenic colonoscopic perforations (0.2%) were diagnosed in 11 patients (seven males and four females). Perforations occurred in six patients during a diagnostic colonoscopy and these occurred in five patients during a therapeutic colonoscopy. Free air in the peritoneum or retroperitoneum was seen in all the patients, as depicted on plain X-rays. Seven patients were treated with surgical intervention and four patients were treated with conservative management. One of the 11 patients with a perforation expired on postoperative day 47 due to infective endocarditis.

Conclusions: The rate of iatrogenic colonoscopic perforation is still very low. Although perforation is a very serious complication and it can be a lethal malady, early recognition and treatment are very critical factors to optimize the patient outcome. Although a gold standard therapeutic modality has not been established, the patients who present with the signs and symptoms of generalized peritonitis are recommended to undergo early surgical intervention. (Korean J Gastrointest Endosc 2009;38:9-13)

Methods: One hundred and thirty-three patients who failed to respond to the initial PPI-based triple therapy received quadruple therapy, whcih consisted of PPI, bismuth, tetracycline and metronidazole. The patients were divided into two groups. One group was treated for 7 days and the other group was treated for 14 days. Four to six weeks after completing the schedule, a ¹³C-urea breath test was performed to detect the presence of H. pylori.

Results: The overall intention-to-treat and per-protocol (PP) eradication rates were 75.2% and 81.1%, respectively. The PP eradication rates for the years 2003∼2004, 2005, 2006 and 2007∼2008 were 76.5%, 82.5%, 91.3% and 75%, respectively. There was no significant difference of the eradication rates according to gender, age and the duration of treatment. Yet the eradication rate of the chronic gastritis group (66.7%) was significantly lower than that of the peptic ulcer group (84.7%) (p=0.030).

Conclusions: There was no definite downward trend for the eradication rates of second-line quadruple therapy during the 6 year study period. However, the eradication rate in the recent 2 years guaranteed only a 75% cure rate and the quadruple therapy was less effective for the patients with chronic gastritis. Therefore, a novel, more potent novel second-line regimen may be needed for the eradication of H. pylori. (Korean J Gastrointest Endosc 2009;38:14-19)