Clinical Endoscopy

Review

Iatrogenic colon perforation: endoscopic management or surgery: Seung Bum Lee; Clin Endosc 2026;59(1):33-39. Published online October 28, 2025; DOI: https://doi.org/10.5946/ce.2025.182

Abstract PDF PubReader ePub: Iatrogenic colonic perforation is a rare but serious complication of colonoscopy, particularly during therapeutic procedures. Prompt recognition and individualized management are essential to prevent adverse outcomes. This review summarizes current treatment strategies based on major international guidelines. Endoscopic closure is recommended for selected cases involving minor defects, early detection, and adequate bowel preparation. Techniques such as clipping, endoloop application, and suturing have demonstrated favorable success rates. Surgical intervention is crucial for larger, delayed, or complicated perforations, particularly those associated with significant contamination or clinical deterioration. Recognizing risk factors such as age, diverticulosis, and inadequate bowel preparation can help prevent this complication.

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Systematic Review and Meta-analysis

Efficacy of endoscopic vacuum therapy in esophageal luminal defects: a systematic review and meta-analysis: Ishaan Vohra, Harishankar Gopakumar, Neil R. Sharma, Srinivas R. Puli; Clin Endosc 2025;58(1):53-62. Published online October 10, 2024; DOI: https://doi.org/10.5946/ce.2023.282

Graphical Abstract Abstract PDF PubReader ePub

Background
/Aims: Endoscopic vacuum-assisted closure (EVAC) is a novel technique used to repair esophageal perforation and leaks. Varying data have been reported on the overall success rate of EVAC. We aimed to conduct a meta-analysis of the available data on the clinical success rate of EVAC.
Methods
Electronic databases were searched for publications addressing the efficacy of EVAC in esophageal luminal defects. Pooling was conducted using both fixed and random-effects models. The overall clinical success of EVAC therapy was considered the primary outcome, whereas, overall complication rates, need for adjunct therapy, and mortality were considered secondary outcomes.
Results
In total, 366 patients were included in the study. On pooled analysis, the mean age was 66 years with 68.32% of patients being men. Overall pooled clinical success rate of EVAC therapy was 87.95%. Upon subgroup analysis, the pooled clinical success rate of postsurgical anastomotic leak and transmural esophageal perforation were found to be 86.57% and 88.89%, respectively. The all-cause hospital mortality was 14% and 4.2% in patients with esophageal perforation and EVAC, respectively.
Conclusions
This study demonstrates that EVAC therapy has a high overall clinical success rate, with low mortality. EVAC therapy seems to be a promising procedure with excellent outcomes in patients with luminal esophageal defects.

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Review

Management of complications related to colorectal endoscopic submucosal dissection: Tae-Geun Gweon, Dong-Hoon Yang; Clin Endosc 2023;56(4):423-432. Published online July 27, 2023; DOI: https://doi.org/10.5946/ce.2023.104

Abstract PDF PubReader ePub

Compared to endoscopic mucosal resection (EMR), colonoscopic endoscopic submucosal dissection (C-ESD) has the advantages of higher en bloc resection rates and lower recurrence rates of colorectal neoplasms. Therefore, C-ESD is considered an effective treatment method for laterally spread tumors and early colorectal cancer. However, C-ESD is technically more difficult and requires a longer procedure time than EMR. In addition to therapeutic efficacy and procedural difficulty, safety concerns should always be considered when performing C-ESD in clinical practice. Bleeding and perforation are the main adverse events associated with C-ESD and can occur during C-ESD or after the completion of the procedure. Most bleeding associated with C-ESD can be managed endoscopically, even if it occurs during or after the procedure. More recently, most perforations identified during C-ESD can also be managed endoscopically, unless the mural defect is too large to be sutured with endoscopic devices or the patient is hemodynamically unstable. Delayed perforations are quite rare, but they require surgical treatment more frequently than endoscopically identified intraprocedural perforations or radiologically identified immediate postprocedural perforations. Post-ESD coagulation syndrome is a relatively underestimated adverse event, which can mimic localized peritonitis from perforation. Here, we classify and characterize the complications associated with C-ESD and recommend management options for them.

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Original Article

Significance of rescue hybrid endoscopic submucosal dissection in difficult colorectal cases: Hayato Yamaguchi, Masakatsu Fukuzawa, Takashi Kawai, Takahiro Muramatsu, Taisuke Matsumoto, Kumiko Uchida, Yohei Koyama, Akira Madarame, Takashi Morise, Shin Kono, Sakiko Naito, Naoyoshi Nagata, Mitsushige Sugimoto, Takao Itoi; Clin Endosc 2023;56(6):778-789. Published online July 26, 2023; DOI: https://doi.org/10.5946/ce.2022.268

Graphical Abstract Abstract PDF Supplementary Material PubReader ePub

Background
/Aims: Hybrid endoscopic submucosal dissection (ESD), in which an incision is made around a lesion and snaring is performed after submucosal dissection, has some advantages in colorectal surgery, including shorter procedure time and preventing perforation. However, its value for rescue resection in difficult colorectal ESD cases remains unclear. This study evaluated the utility of rescue hybrid ESD (RH-ESD).
Methods
We divided 364 colorectal ESD procedures into the conventional ESD group (C-ESD, n=260), scheduled hybrid ESD group (SH-ESD, n=69), and RH-ESD group (n=35) and compared their clinical outcomes.
Results
Resection time was significantly shorter in the following order: RH-ESD (149 [90–197] minutes) >C-ESD (90 [60–140] minutes) >SH-ESD (52 [29–80] minutes). The en bloc resection rate increased significantly in the following order: RH-ESD (48.6%), SH-ESD (78.3%), and C-ESD (97.7%). An analysis of factors related to piecemeal resection of RH-ESD revealed that the submucosal dissection rate was significantly lower in the piecemeal resection group (25% [20%–30%]) than in the en bloc resection group (40% [20%–60%]).
Conclusions
RH-ESD was ineffective in terms of curative resection because of the low en bloc resection rate, but was useful for avoiding surgery.

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Review

Endoscopic retrograde cholangiopancreatography-related complications: risk stratification, prevention, and management: Clement Chun Ho Wu, Samuel Jun Ming Lim, Christopher Jen Lock Khor; Clin Endosc 2023;56(4):433-445. Published online July 17, 2023; DOI: https://doi.org/10.5946/ce.2023.013

Abstract PDF Supplementary Material PubReader ePub

Endoscopic retrograde cholangiopancreatography (ERCP) plays a crucial role in the management of pancreaticobiliary disorders. Although the ERCP technique has been refined over the past five decades, it remains one of the endoscopic procedures with the highest rate of complications. Risk factors for ERCP-related complications are broadly classified into patient-, procedure-, and operator-related risk factors. Although non-modifiable, patient-related risk factors allow for the closer monitoring and instatement of preventive measures. Post-ERCP pancreatitis is the most common complication of ERCP. Risk reduction strategies include intravenous hydration, rectal nonsteroidal anti-inflammatory drugs, and pancreatic stent placement in selected patients. Perforation is associated with significant morbidity and mortality, and prompt recognition and treatment of ERCP-related perforations are key to ensuring good clinical outcomes. Endoscopy plays an expanding role in the treatment of perforations. Specific management strategies depend on the location of the perforation and the patient’s clinical status. The risk of post-ERCP bleeding can be attenuated by preprocedural optimization and adoption of intra-procedural techniques. Endoscopic measures are the mainstay of management for post-ERCP bleeding. Escalation to angioembolization or surgery may be required for refractory bleeding. Post-ERCP cholangitis can be reduced with antibiotic prophylaxis in high risk patients. Bile culture-directed therapy plays an important role in antimicrobial treatment.

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Focused Review Series: Endoscopic Managements of Postoperative Gastrointestinal Complication: What’s New?

Over-the-Scope Clip in the Treatment of Gastrointestinal Leaks and Perforations: Mike T. Wei, Ji Yong Ahn, Shai Friedland; Clin Endosc 2021;54(6):798-804. Published online November 30, 2021; DOI: https://doi.org/10.5946/ce.2021.250

Abstract PDF PubReader ePub

While perforations, postoperative fistulas, and leaks have traditionally led to surgical or interventional radiology consultation for management, the introduction of the over-the-scope clip has allowed increased therapeutic possibilities for endoscopists. While primarily limited to case reports and series, the over-the-scope clip successfully manages gastrointestinal bleeding, perforations, as well as postoperative leaks and fistulas. Retrospective studies have demonstrated a relatively high success rate and a low complication rate. Given the similarity to variceal banding equipment, the learning curve with the over-the-scope clip is rapid. However, given the higher risk of procedures involving the use of the over-the-scope clip, it is essential to obtain the scope in a stable position and grasp sufficient tissue with the cap using a grasping tool and/or suction. From our experience, while closure may be successful in lesions sized up to 3 cm, successful outcomes are obtained for lesions sized <1 cm. Ultimately, given the limited available data, prospective randomized trials are needed to better evaluate the utility of the over-the-scope clip in various clinical scenarios, including fistula and perforation management.

Citations

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Current Status of Endoscopic Vacuum Therapy in the Management of Esophageal Perforations and Post-Operative Leaks: Imogen Livingstone, Lily Pollock, Bruno Sgromo, Sotiris Mastoridis; Clin Endosc 2021;54(6):787-797. Published online November 16, 2021; DOI: https://doi.org/10.5946/ce.2021.240

Abstract PDF PubReader ePub

Esophageal wall defects, including perforations and postoperative leaks, are associated with high morbidity and mortality and pose a significant management challenge. In light of the high morbidity of surgical management or revision, in recent years, endoscopic vacuum therapy (EVT) has emerged as a novel alternative treatment strategy. EVT involves transoral endoscopic placement of a polyurethane sponge connected to an externalized nasogastric tube to provide continuous negative pressure with the intention of promoting defect healing, facilitating cavity drainage, and ameliorating sepsis. In the last decade, EVT has become increasingly adopted in the management of a diverse spectrum of esophageal defects. Its popularity has been attributed in part to the growing body of evidence suggesting superior outcomes and defect closure rates in excess of 80%. This growing body of evidence, coupled with the ongoing evolution of the technology and techniques of deployment, suggests that the utilization of EVT has become increasingly widespread. Here, we aimed to review the current status of the field, addressing the mechanism of action, indications, technique methodology, efficacy, safety, and practical considerations of EVT implementation. We also sought to highlight future directions for the use of EVT in esophageal wall defects.

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Case Reports

Endoscopic Treatment of Iatrogenic Perforation of Sigmoid Diverticulum: A Case Report of Multidisciplinary Management: Giacomo Emanuele Maria Rizzo, Giuseppina Ferro, Giovanna Rizzo, Giovanni Di Carlo, Alessandro Cantone, Gaetano Giuseppe Di Vita, Carmelo Sciumè; Clin Endosc 2022;55(2):292-296. Published online June 7, 2021; DOI: https://doi.org/10.5946/ce.2021.005

Abstract PDF PubReader ePub: Iatrogenic perforations are severe complications of gastrointestinal endoscopy; therefore, their management should be adequately planned. A 77-year-old man with a history of diverticulosis underwent a colonoscopy for anemia. During the procedure, an iatrogenic perforation occurred suddenly in the sigmoid colon, near a severe angle among the numerous diverticula. Through-the-scope clips were immediately applied to treat it and close mucosal edges. Laboratory tests showed increased levels of inflammation and infection, and although there were no complaints of abdominal pain, the patient had an extremely distended abdomen. A multidisciplinary board began management based on a conservative approach. Pneumoperitoneum was treated with computed tomography-assisted drainage. After 72 hours, his intestinal canalization and laboratory tests were normal. Though this adverse event is rare, a multidisciplinary board should be promptly gathered upon occurrence, even if the patient appears clinically stable, to consider a conservative approach and avoid surgical treatment.

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Intestinal Perforation Caused by Lumboperitoneal Shunt Insertion Repaired with an Over-the-Scope Clip: Naoki Ishizuka, Eiji Komatsu; Clin Endosc 2022;55(1):146-149. Published online March 3, 2021; DOI: https://doi.org/10.5946/ce.2020.293

Abstract PDF PubReader ePub

Lumboperitoneal or ventriculoperitoneal shunt insertion is a standard therapy for hydrocephalus that diverts cerebrospinal fluid from the subarachnoid space into the peritoneal cavity. Gastrointestinal perforations due to this procedure occur rarely; however, accepted treatment strategies have not yet been established. Hence, the most common treatment approaches are open surgery or spontaneous closure without endoscopy. We report the case of a small intestinal perforation in a 73-year-old-woman that occurred after the insertion of a lumboperitoneal shunt. A positive cerebrospinal fluid culture and high cerebrospinal fluid white blood cell count indicated a retrograde bacterial infection, and computed tomography revealed that the peritoneal tip of the shunt catheter was located in the lumen of the gastrointestinal tract. We repaired the perforation endoscopically using an over-the-scope clip, and the patient’s recovery was uneventful. Use of an over-the-scope clip could be an effective and minimally invasive treatment for intestinal perforations caused by lumboperitoneal or ventriculoperitoneal shunt insertion.

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Progress in Surgical Treatment of Traffic Hydrocephalus
飞张
Advances in Clinical Medicine.2021; 11(09): 3942. CrossRef

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Original Article

Diode Laser—Can It Replace the Electrical Current Used in Endoscopic Submucosal Dissection?: Yunho Jung, Gwang Ho Baik, Weon Jin Ko, Bong Min Ko, Seong Hwan Kim, Jin Seok Jang, Jae-Young Jang, Wan-Sik Lee, Young Kwan Cho, Sun Gyo Lim, Hee Seok Moon, In Kyung Yoo, Joo Young Cho; Clin Endosc 2021;54(4):555-562. Published online January 13, 2021; DOI: https://doi.org/10.5946/ce.2020.229

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Background
/Aims: A new medical fiber-guided diode laser system (FDLS) is expected to offer high-precision cutting with simultaneous hemostasis. Thus, this study aimed to evaluate the feasibility of using the 1,940-nm FDLS to perform endoscopic submucosal dissection (ESD) in the gastrointestinal tract of an animal model.
Methods
In this prospective animal pilot study, gastric and colorectal ESD using the FDLS was performed in ex vivo and in vivo porcine models. The completeness of en bloc resection, the procedure time, intraprocedural bleeding, histological injuries to the muscularis propria (MP) layer, and perforation were assessed.
Results
The en bloc resection and perforation rates in the ex vivo study were 100% (10/10) and 10% (1/10), respectively; those in the in vivo study were 100% (4/4) and 0% for gastric ESD and 100% (4/4) and 25% (1/4) for rectal ESD, respectively. Deep MP layer injuries tended to occur more frequently in the rectal than in the gastric ESD cases, and no intraprocedural bleeding occurred in either group.
Conclusions
The 1,940-nm FDLS was capable of yielding high en bloc resection rates without intraprocedural bleeding during gastric and colorectal ESD in animal models.

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Zi-yi Ma, Zhen Yang, Jia Liu, Xue Peng, Xu-biao Nie, Pai-pai Qi, Quan-bing Jiang, Wei-Hao Kok, En Liu, Chao-qiang Fan
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Faming Liu, Jiyang Li, Ting Wang, Bing Xue, Yishan Lv, Jie Zhang, Felix J.F. Herth
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Endoscopy International Open.2022; 10(04): E386. CrossRef

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Case Report

Perforation of a Gastric Tear during Esophageal Endoscopic Submucosal Dissection under General Anesthesia: Tomoaki Yamasaki, Yuhei Sakata, Takehisa Suekane, Hiroko Nebiki; Clin Endosc 2021;54(6):916-919. Published online November 12, 2020; DOI: https://doi.org/10.5946/ce.2020.220

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Mallory-Weiss tears (MWT) are occasionally encountered during endoscopic procedures. Esophageal endoscopic submucosal dissection (ESD) is widely performed under general anesthesia to avoid unexpected body movements. We present the case of a 68-year-old woman with squamous cell carcinoma. Although ESD was performed under general anesthesia, a gastric perforation at the MWT caused by gastric inflation was observed after the procedure. The perforation was closed endoscopically, and she was discharged without any sequelae. Although general anesthesia is useful for esophageal ESD, it should be noted that it can cause MWT, and in rare cases, gastric perforation, due to gastric inflation during the procedure.

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Gastric Perforation Encountered during Duodenal Stent Insertion
Sung Woo Ko, Hoonsub So, Sung Jo Bang
The Korean Journal of Gastroenterology.2022; 80(5): 221. CrossRef

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Original Article

Dedicated Cold Snare vs. Traditional Snare for Polypectomy of Diminutive and Small Lesions in a Porcine Model: A Research Group for Endoscopic Instruments and Stents (REIS) Study: Han Hee Lee, Bo-In Lee, Jung-Wook Kim, Hyun Lim, Si Hyung Lee, Jun-Hyung Cho, Yunho Jung, Kyoung Oh Kim, Chan Gyoo Kim, Kee Myung Lee, Jong-Jae Park, Myung-Gyu Choi, Hoon Jai Chun, Ho Gak Kim; Clin Endosc 2021;54(3):390-396. Published online September 10, 2020; DOI: https://doi.org/10.5946/ce.2020.096

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Background
/Aims: The aim of this in vivo animal study was to evaluate the effectiveness and safety of dedicated cold snare (DCS) compared with those of traditional snare (TS) for cold snare polypectomy (CSP).
Methods
A total of 36 diminutive (5 mm) and 36 small (9 mm) pseudolesions were made by electrocoagulation in the colons of mini-pigs.
Results
For the diminutive lesions, there were no significant differences in technical success rate, procedure time, or complete resection rate between the DCS and TS groups; the rate of uneven resection margin in the DCS group was significantly lower than that of the TS group. For small lesions, technical success rate and complete resection rate were significantly higher in the DCS group than in the TS group (100% [18/18] vs. 55.6% [10/18], p=0.003; 94.4% [17/18] vs. 40% [4/10], p=0.006). In addition, the procedure duration was significantly shorter, and the rate of uneven resection margin was significantly lower in the DCS group (28.5 sec vs. 66.0 sec, p=0.006; 11.1% [2/18] vs. 100% [10/10], p<0.001). Two cases of perforation occurred in the DCS group. Multivariate analysis revealed that DCS use was independently associated with complete resection.
Conclusions
DCS is superior to TS in terms of technical success, complete resection, and reducing the duration of the procedure for CSP of small polyps.

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Focused Review Series: The Roles of Endoscopy in the Management of Colonic Obstruction and Perforation

Endoscopic Management of Iatrogenic Colon Perforation: Yunho Jung; Clin Endosc 2020;53(1):29-36. Published online July 3, 2019; DOI: https://doi.org/10.5946/ce.2019.061

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Colon perforations are difficult to resolve because they occur unexpectedly and infrequently. If the clinician is unprepared or lacks training in dealing with perforations, the clinical prognosis will be affected, which can lead to legal issues. We describe here the proper approach to the management of perforations, including deciding on endoscopic or surgical treatment, selection of endoscopic devices, endoscopic closure procedures, and general management of perforations that occur during diagnostic or therapeutic colonoscopy.

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Focused Review Series: Endoscopic Submucosal Dissection for Colorectal Tumors

Management of Complications of Colorectal Submucosal Dissection: Eun Ran Kim, Dong Kyung Chang; Clin Endosc 2019;52(2):114-119. Published online March 29, 2019; DOI: https://doi.org/10.5946/ce.2019.063

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Endoscopic submucosal dissection (ESD) is a useful procedure for the treatment of superficial gastrointestinal neoplasm. Compared with endoscopic mucosal resection (EMR), ESD has several benefits, which include resectability of various difficult lesion, accurate histologic assessment of specimen, and lower recurrence rate. However, the risk of procedure- related complications is higher with ESD than with EMR. Moreover, because the colon has a thin wall and limited endoscopic maneuverability, ESD is considered a more challenging and risky procedure when performed in the colon than in the stomach. ESD-related complications are more likely to occur. The significant complications associated with ESD are bleeding, perforation, coagulation syndrome and stenosis, most of which can be treated and prevented by endoscopic intervention and preparation. Therefore, it is important to know how to occur and manage the ESD related complication.

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Case Reports

Stomach Perforation Caused by Ingesting Liquid Nitrogen: A Case Report on the Effect of a Dangerous Snack: Dong-Wook Kim; Clin Endosc 2018;51(4):381-383. Published online March 5, 2018; DOI: https://doi.org/10.5946/ce.2017.178

Abstract PDF PubReader ePub

We report our experience with a case of stomach perforation after accidental ingestion of liquid nitrogen. A 13-year-old boy ate a snack at an amusement park and began to complain of sudden onset of severe abdominal pain with shortness of breath. It was determined that the snack he had ingested had been cooled with liquid nitrogen. A computed tomography scan of the abdomen and a chest X-ray showed a large volume of pneumoperitoneum. During surgery, a 4-cm perforation of the angularis incisura of the stomach was identified. Primary repair and omentopexy was performed. The patient was discharged without postoperative complications.

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An Unusual Case of Ovarian Carcinomatosis with Microscopic Tumor Embolism Leading to Rectal Ischemia and Perforation: Man Hon Tang, Jason Lim, Inny Bushmani, Chee Yung Ng; Clin Endosc 2018;51(3):294-298. Published online February 22, 2018; DOI: https://doi.org/10.5946/ce.2017.152

Abstract PDF PubReader ePub

We present an unusual case of advanced ovarian carcinoma with postoperative complications of ischemia and perforation of the rectum as a result of tumor embolism. The interval progression from ischemia to infarction of the rectum was captured in repeated sigmoidoscopies. A brief discussion on tumor embolism and management of this case is also included.

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Role of Endoscopy in the Management of Boerhaave Syndrome: Juan Ignacio Tellechea, Jean-Michel Gonzalez, Pablo Miranda-García, Adrian Culetto, Xavier Benoit D’Journo, Pascal Alexandre Thomas, Marc Barthet; Clin Endosc 2018;51(2):186-191. Published online September 20, 2017; DOI: https://doi.org/10.5946/ce.2017.043

Abstract PDF PubReader ePub

Boerhaave syndrome (BS) is a spontaneous esophageal perforation which carries high mortality. Surgical treatment is well established, but the development of interventional endoscopy has proposed new therapies. We expose our experience in a Gastrointestinal and Endoscopy Unit. With a retrospective, observational, open-label, single center, consecutive case series. All patients diagnosed with BS who were managed in our center were included. Treated conservatively, endoscopically or surgically, according to their clinical condition and lesion presentation. Fourteen patients were included. Ten were treated with primary surgery. One conservatively. In total, 7/14 patients required an endoscopic treatment. All required metallic stents deployment, 3 cases over-the-scope-clips concomitantly and one case a novel technique an internal drain. 6/7 cases endoscopically treated achieved complete esophageal healing. In conclusion, endoscopy is an useful tool at all stages BS management: difficult diagnosis, primary treatment in selected patients and as salvage when surgery fails. With mortality rates and outcomes comparables to surgery.

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Original Article

Efficacy of the Over-the-Scope Clip System for Treatment of Gastrointestinal Fistulas, Leaks, and Perforations: A Korean Multi-Center Study: Hang Lak Lee, Joo Young Cho, Jun-Hyung Cho, Jong Jae Park, Chan Gyoo Kim, Seong Hwan Kim, Joung-Ho Han; Clin Endosc 2018;51(1):61-65. Published online August 29, 2017; DOI: https://doi.org/10.5946/ce.2017.027

Abstract PDF PubReader ePub

Background
/Aims: Currently, a new over-the-scope clip (OTSC) system has been introduced. This system has been used for gastrointestinal perforations and fistulas in other countries. The aim of our study is to examine the therapeutic success rate of endoscopic treatment using the OTSC system in Korea.
Methods
This was a multicenter prospective study. A total of seven endoscopists at seven centers performed this procedure.
Results
A total of 19 patients were included, with gastrointestinal leakages from anastomosis sites, fistulas, or esophageal perforations due to Boerhaave’s syndrome. Among these, there were three gastrojejunostomy sites, three esophagojejunostomy sites, four esophagogastrostomy sites, one esophagocolonostomy site, one jejuno-jejunal site, two endoscopic full thickness resection site closures, one Boerhaave’s syndrome, two esophago-bronchial fistulas, one gastrocolonic fistula, and one colonopseudocyst fistula. The size of the leakage ranged from 5 to 30 mm. The median procedure time was 16 min. All cases were technically successful. Complete closure of the leak was achieved in 14 of 19 patients using OTSC alone.
Conclusions
The OTSC system is a safe and effective method for the management of gastrointestinal leakage, especially in cases of anastomotic leakage after surgery.

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Case Report

Gastric Perforation Caused by an Intragastric Balloon: Endoscopic Findings: In Kyung Yoo, Hoon Jai Chun, Yoon Tae Jeen; Clin Endosc 2017;50(6):602-604. Published online May 18, 2017; DOI: https://doi.org/10.5946/ce.2017.015

Abstract PDF Supplementary Material PubReader ePub

Intragastric balloon (IGB) insertion has been most frequently used in the West as an effective endoscopic treatment for morbid obesity, in practice. Recently, there is a growing number of cases requiring IGB deployment for obesity treatment in Korea. One of the reported complications of IGB use is gastric perforation. A 47-year-old woman was admitted to the hospital with mild symptoms, 7 weeks after having an IGB placed. Esophagogastroduodenoscopy was performed and gastric ulcer perforation was observed in the ulcer base, where food particles were impacted. Laparoscopic primary repair was done successfully. This was a case of gastric perforation, secondary to poor compliance with a proton-pump inhibitor (PPI). PPI and Helicobacter pylori eradication are important for ulcer prevention following IGB deployment.

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Review

Pneumothorax after Colonoscopy – A Review of Literature: Ajay Gupta, Hammad Zaidi, Khalid Habib; Clin Endosc 2017;50(5):446-450. Published online April 10, 2017; DOI: https://doi.org/10.5946/ce.2016.118

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The purpose of this study was to determine the anatomical aspects, mechanisms, risk factors and appropriate management of development of pneumothorax during a routine colonoscopy. A systematic search of the literature (MEDLINE, Embase and Google Scholar) revealed 21 individually documented patients of pneumothorax following a colonoscopy, published till December 2015. One additional patient treated at our center was added. A pooled analysis of these 22 patients was performed including patient characteristics, indication of colonoscopy, any added procedure, presenting symptoms,risk factors and treatment given. The review suggested that various risk factors may be female gender, therapeutic interventions, difficult colonoscopy and underlying bowel pathology. Diagnosis of this condition requires a high index of suspicion and treatment should be tailored to individual needs.

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Pneumothorax, Pneumomediastinum, Pneumoperitoneum, Pneumoretroperitoneum, and Cervical Emphysema After Colonoscopy: A Case Report
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Case Reports

Endoscopic Management of Gastrointestinal Leaks and Perforation with Polyglycolic Acid Sheets: Sojung Han, Hyunsoo Chung, Jun Chul Park, Sung Kwan Shin, Sang Kil Lee, Yong Chan Lee; Clin Endosc 2017;50(3):293-296. Published online March 8, 2017; DOI: https://doi.org/10.5946/ce.2016.121

Abstract PDF PubReader ePub

Gastrointestinal (GI) leakage, fistulae, and perforations can be serious and life threatening. There has been a paradigm shift in the management approach of these conditions, from surgical to conservative, including endoscopic management. Here, we report two cases of endoscopic closure of a GI fistula and perforation using polyglycolic acid (PGA) sheets with fibrin glue. The first case is of an anastomotic leak detected after subtotal gastrectomy with gastroduodenostomy. After failed application of endoclips, a PGA sheet was applied, and the fistula was successfully closed. The second case was of a 15-mm large perforated gastric ulcer, which was also successfully closed with a PGA sheet. This is the first case report that PGA sheet was used for the treatment of overt perforation. The outcome of these cases suggest that endoscopic closure using PGA sheets can be considered as a useful alternative for the management of GI leakage, fistulae, and perforations.

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Case Reports in Gastroenterology.2018; 12(3): 679. CrossRef

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Repair of an Endoscopic Retrograde Cholangiopancreatography-Related Large Duodenal Perforation Using Double Endoscopic Band Ligation and Endoclipping: Keunmo Kim, Eun Bee Kim, Yong Hyeok Choi, Youngmin Oh, Joung-Ho Han, Seon Mee Park; Clin Endosc 2017;50(2):202-205. Published online September 13, 2016; DOI: https://doi.org/10.5946/ce.2016.112

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Endoscopic closure techniques have been introduced for the repair of duodenal wall perforations that occur during endoscopic retrograde cholangiopancreatography (ERCP). We report a case of successful repair of a large duodenal wall perforation by using double endoscopic band ligation (EBL) and an endoclip. Lateral duodenal wall perforation occurred during ERCP in a 93-year-old woman with acute calculous cholangitis. We switched to a forward endoscope that had a transparent band apparatus. A 2.0-cm ovalshaped perforation was found at the lateral duodenal wall. We repaired the perforation by sequentially performing double EBL and endoclipping. The first EBL was performed at the proximal edge of the perforation orifice, and two-thirds of the perforation were repaired. The second EBL, which also included the contents covered under the first EBL, repaired the defect almost completely. Finally, to account for the possible presence of a residual perforation, an endoclip was applied at the distal end of the perforation. The detection and closure of the perforation were completed within 10 minutes. We suggest that double EBL is an effective method for closure.

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Endoscopic treatment of ERCP-related duodenal perforation
Nicole Evans, James L. Buxbaum
Techniques in Gastrointestinal Endoscopy.2019; 21(2): 83. CrossRef

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Reviews

Endoscopic Closure for Full-Thickness Gastrointestinal Defects: Available Applications and Emerging Innovations: Nobuyoshi Takeshita, Khek Yu Ho; Clin Endosc 2016;49(5):438-443. Published online August 30, 2016; DOI: https://doi.org/10.5946/ce.2016.104

Abstract PDF PubReader ePub

Full-thickness gastrointestinal defects such as perforation, anastomotic leak, and fistula are severe conditions caused by various types of pathologies. They are more likely to require intensive care and a long hospital stay and have high rates of morbidity and mortality. After intentional full-thickness opening of hollow organs for natural orifice transluminal endoscopic surgery, safe and secure closure is urgently required. The currently available advanced endoscopic closing techniques have a major role in the treatment of full-thickness gastrointestinal defects. Appropriate usage of these techniques requires taking into account their advantages and limitations during practical application. We reviewed the available endoscopic modalities, including endoscopic clips, stents, vacuum-assisted closure, gap filling, and suturing devices, discussed their advantages and limitations when treating full-thickness gastrointestinal defects, and explored emerging innovations, including a novel endoluminal surgical platform for versatile suturing and a cell-laden scaffold for effective gap filling. Although these emerging technologies still require further pre-clinical and clinical trials to assess their feasibility and efficacy, the available modalities may be replaced and refined by these new techniques in the near future.

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Recent Advanced Endoscopic Management of Endoscopic Retrograde Cholangiopancreatography Related Duodenal Perforations: Seon Mee Park; Clin Endosc 2016;49(4):376-382. Published online July 29, 2016; DOI: https://doi.org/10.5946/ce.2016.088

Abstract PDF PubReader ePub

The management strategy for endoscopic retrograde cholangiopancreatography-related duodenal perforation can be determined based on the site and extent of injury, the patient’s condition, and time to diagnosis. Most cases of perivaterian or bile duct perforation can be managed with a biliary stent or nasobiliary drainage. Duodenal wall perforations had been treated with immediate surgical repair. However, with the development of endoscopic devices and techniques, endoscopic closure has been reported to be a safe and effective treatment that uses through-the-scope clips, ligation band, fibrin glue, endoclips and endoloops, an over-the-scope clipping device, suturing devices, covering luminal stents, and open-pore film drainage. Endoscopic therapy could be instituted in selected patients in whom perforation was identified early or during the procedure. Early diagnosis, proper conservative management, and effective endoscopic closure are required for favorable outcomes of non-surgical management. If endoscopic treatment fails, or in the cases of clinical deterioration, prompt surgical management should be considered.

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Case Report

Delayed Severe Hemobilia after Endoscopic Biliary Plastic Stent Insertion: Sung Hak Lee, Seung Goun Hong, Kyoung yong Lee, Pyung Kang Park, Sung Du Kim, Mahn Lee, Dong Wook Yu, Man Yong Hong; Clin Endosc 2016;49(3):303-307. Published online March 25, 2016; DOI: https://doi.org/10.5946/ce.2015.081

Abstract PDF PubReader ePub

Hemobilia is a rare gastrointestinal bleeding, usually caused by injury to the bile duct. Hemobilia after endoscopic retrograde cholangiopancreatography (ERCP) is generally self-limiting and patients will spontaneously recover, but some severe and fatal hemorrhages have been reported. ERCP-related bowel or bile duct perforation should be managed promptly, according to the type of injury and the status of the patient. We recently experienced a case of late-onset severe hemobilia in which the patient recovered after endoscopic biliary stent insertion. The problem was attributable to ERCP-related bile duct perforation during stone removal, approximately 5 weeks prior to the hemorrhagic episode. The removal of the stent was performed 10 days before the onset of hemobilia. The bleeding was successfully treated by two sessions of transarterial coil embolization.

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Original Article

Optimal Methods for the Management of Iatrogenic Colonoscopic Perforation: Dae Kyu Shin, Sun Young Shin, Chi Young Park, Sun Mi Jin, Yang Hyun Cho, Won Hee Kim, Chang-Il Kwon, Kwang Hyun Ko, Ki Baik Hahm, Pil Won Park, Jong Woo Kim, Sung Pyo Hong; Clin Endosc 2016;49(3):282-288. Published online February 18, 2016; DOI: https://doi.org/10.5946/ce.2015.046

Abstract PDF PubReader ePub

Background
/Aims: Colonoscopic perforations have been managed with exploratory laparotomy, and have resulted in some morbidity and mortality. Recently, laparoscopic surgery is commonly performed for this purpose. The aim of this study was to compare the outcomes of several management strategies for iatrogenic colonoscopic perforations.
Methods
We retrospectively reviewed the medical records of patients who had been treated for colonoscopic perforation between January 2004 and April 2013 at CHA Bundang Medical Center in Korea.
Results
A total of 41 patients with colonoscopic perforation were enrolled. Twenty patients underwent conservative management with a success rate of 90%. Surgical management was performed in 23 patients including two patients who were converted to surgical management after the failure of the initial conservative management. Among 14 patients who underwent surgery at 8 hours after the perforation, there was no considerable difference in adverse outcomes between the laparotomy group and the laparoscopic surgery group. The medical costs and claim rate were 1.45 and 1.87 times greater in the exploratory laparotomy group, respectively.
Conclusions
Conservative management of colonoscopic perforation could be an option for patients without overt symptoms of peritonitis or with a small defect size. If surgical management is required, laparoscopic surgery may be considered as the initial procedure even with a delayed diagnosis.

Citations

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Surgical repair of endoscopy-induced colonic perforations: a case-matched study of short-term morbidity and mortality
Fady DANIEL, Suha JABAK, Mohammad HOSNI, Hani TAMIM, Aurelie MAILHAC, Ayman ALRAZIM, Noura AL-ALI, Robert CHURCH, Mohammad KHALIFE, Shafik SIDANI, Faek JAMALI
Minerva Surgery.2024;[Epub] CrossRef
Laparoscopic versus open surgery for colonoscopic perforation: A systematic review and meta-analysis
Wu Zhong, Chuanyuan Liu, Chuanfa Fang, Lei Zhang, Xianping He, Weiquan Zhu, Xueyun Guan
Medicine.2023; 102(24): e34057. CrossRef
Elastography for Pediatric Chronic Liver Disease
Giovanna Ferraioli, Richard G. Barr, Jonathan R. Dillman
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Clinical outcomes of laparoscopic versus open surgery for repairing colonoscopic perforation: a multicenter study
Jae Seok Lee, Jeong Yeon Kim, Byung Mo Kang, Sang Nam Yoon, Jun Ho Park, Bo Young Oh, Jong Wan Kim
Surgery Today.2021; 51(2): 285. CrossRef
The analysis of outcomes of surgical management for colonoscopic perforations: A 16-years experiences at a single institution
Dae Ro Lim, Jung Kul Kuk, Taehyung Kim, Eung Jin Shin
Asian Journal of Surgery.2020; 43(5): 577. CrossRef
Multicenter retrospective evaluation of ileocecocolic perforations associated with diagnostic lower gastrointestinal endoscopy in dogs and cats
Vanessa L. Woolhead, Jacqueline C. Whittemore, Sarah A. Stewart
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Endoscopic Management of the Ascending Colon Perforation Secondary to a Rare-Earth Magnets Ingestion in a Pediatric Patient
Sandra Mabel Camacho-Gomez, James Meredith Noel, Robert Adam Noel
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Pseudo‐obstruction But a Real Perforation

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Alexander T. Hawkins, Kenneth W. Sharp, Molly M. Ford, Roberta L. Muldoon, M. Benjamin Hopkins, Timothy M. Geiger
The American Journal of Surgery.2018; 215(4): 712. CrossRef
2017 WSES guidelines for the management of iatrogenic colonoscopy perforation
Nicola de’Angelis, Salomone Di Saverio, Osvaldo Chiara, Massimo Sartelli, Aleix Martínez-Pérez, Franca Patrizi, Dieter G. Weber, Luca Ansaloni, Walter Biffl, Offir Ben-Ishay, Miklosh Bala, Francesco Brunetti, Federica Gaiani, Solafah Abdalla, Aurelien Ami
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Management Outcomes of Colonoscopic Perforations Are Affected by the General Condition of the Patients
Jae Ho Park, Kyung Jong Kim
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Mircea Gabriel Mureșan, Ioan Alexandru Balmoș, Iudita Badea, Ario Santini
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Laparoscopic vs. open surgery for the treatment of iatrogenic colonoscopic perforations: a systematic review and meta-analysis
Aleix Martínez-Pérez, Nicola de’Angelis, Francesco Brunetti, Yann Le Baleur, Carmen Payá-Llorente, Riccardo Memeo, Federica Gaiani, Marco Manfredi, Paschalis Gavriilidis, Giorgio Nervi, Federico Coccolini, Aurelien Amiot, Iradj Sobhani, Fausto Catena, Gia
World Journal of Emergency Surgery.2017;[Epub] CrossRef
Urinary Bladder Injury During Colonoscopy Without Colon Perforation
Jung Wook Suh, Jun Won Min, Hwan Namgung, Dong-Guk Park
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Case Report

Unexpected Delayed Colon Perforation after the Endoscopic Submucosal Dissection with Snaring of a Laterally Spreading Tumor: Young Bo Ko, Jeong-Mi Lee, Wan Soo Kim, Min Seob Kwak, Ji Wan Lee, Dong Yeol Shin, Dong-Hoon Yang, Jeong-Sik Byeon; Clin Endosc 2015;48(6):570-575. Published online November 30, 2015; DOI: https://doi.org/10.5946/ce.2015.48.6.570

Abstract PDF PubReader ePub

Colonic perforation may occur as a complication of diagnostic and therapeutic colonoscopy. The risk factors for perforation after colorectal endoscopic submucosal dissection (ESD) include an inexperienced endoscopist, a large tumor size, and submucosal fibrosis. The mechanisms of perforation include unintended endoscopic resection/dissection and severe thermal injury. Here, we report a case of colon perforation that occurred after ESD with snaring of a laterally spreading tumor. The perforation was completely unexpected because there were no colorectal ESD-associated risk factors for perforation, deep dissection, or severe coagulation injury in our patient.

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Iatrogenic colon perforation: endoscopic management or surgery
Seung Bum Lee
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Elucidation of the process of delayed colonic perforation after endoscopic thermal injury in a rat model
Takahiro Sakae, Hidehito Maeda, Fumisato Sasaki, Yuko Nakamura, Naohiro Koyoshi, Shohei Uehara, Akihito Tanaka, Makoto Hinokuchi, Shiho Arima, Shinichi Hashimoto, Shuji Kanmura, Akio Ido
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Clinical outcomes and risk factors of post-polypectomy microperforation in patients with colorectal neoplasia: a case-control study
Seung Yong Shin, Min Soo Cho, Jinhoon Nam, Jie-Hyun Kim, Young Hoon Yoon, Hyojin Park, Jeonghyun Kang, Jae Jun Park
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Yuki Kamigaichi, Shiro Oka, Shinji Tanaka, Shinji Nagata, Masaki Kunihiro, Toshio Kuwai, Yuko Hiraga, Akira Furudoi, Seiji Onogawa, Hideharu Okanobu, Takeshi Mizumoto, Tomohiro Miwata, Shiro Okamoto, Kenichi Yoshimura, Kazuaki Chayama
Surgical Endoscopy.2022; 36(8): 5698. CrossRef
Life on a knife edge: the optimal approach to the management of perforations during endoscopic submucosal dissection (ESD)
Shria Kumar, Young Hoon Youn, Jeffrey H. Lee
Expert Review of Gastroenterology & Hepatology.2020; 14(10): 965. CrossRef
Delayed perforation after endoscopic resection of a colonic laterally spreading tumor: A case report and literature review
Ge-Yu-Jia Zhou, Jin-Long Hu, Sheng Wang, Nan Ge, Xiang Liu, Guo-Xin Wang, Si-Yu Sun, Jin-Tao Guo
World Journal of Clinical Cases.2020; 8(16): 3608. CrossRef
Predicting and managing complications following colonoscopy: risk factors and management of advanced interventional endoscopy with a focus on colorectal ESD
Hiroyuki Takamaru, Rina Goto, Masayoshi Yamada, Taku Sakamoto, Takahisa Matsuda, Yutaka Saito
Expert Review of Medical Devices.2020; 17(9): 929. CrossRef
Cost Analysis of Endoscopic Submucosal Dissection for the Treatment of Colorectal Lesions in China
Ning Cui, Yu Zhao, Honggang Yu
BioMed Research International.2019; 2019: 1. CrossRef
Delayed perforation after endoscopic submucosal dissection for mucosal colon cancer: A conservatively treated case
Kazumasa Kawashima, Takuto Hikichi, Tatsuo Fujiwara, Naohiko Gunji, Jun Nakamura, Ko Watanabe, Kyoko Katakura, Hiromasa Ohira
FUKUSHIMA JOURNAL OF MEDICAL SCIENCE.2018; 64(3): 157. CrossRef

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Original Articles

Endoluminal Closure of Colon Perforation with Endoscopic Band Ligation: Technical Feasibility and Safety in an In Vivo Canine Model: Joung-Ho Han, Myounghwan Kim, Tae Hoon Lee, Hyun Kim, Yunho Jung, Seon Mee Park, Heebok Chae, Seijin Youn, Ji Yun Shin, In-Kwang Lee, Tae Soo Lee, Seok Hwa Choi; Clin Endosc 2015;48(6):534-541. Published online November 30, 2015; DOI: https://doi.org/10.5946/ce.2015.48.6.534

Abstract PDF PubReader ePub

Background
/Aims: Endoscopic band ligation (EBL) is an accepted method in the management of variceal bleeding; however, there is little evidence on the safety and feasibility of EBL for the closure of bowel perforation. In this study, we aimed to evaluate the technical feasibility and efficacy of EBL in iatrogenic colon perforation by using a canine model.
Methods
We established an iatrogenic colon perforation model by using seven beagle dogs. Longitudinal 1.5- to 1.7-cm colon perforations were created with a needle knife and an insulated-tip knife, and the perforation was subsequently closed with EBL. During a 2-week follow-up period, the animals were carefully monitored and then euthanized for pathologic examination.
Results
The EBL of iatrogenic colon perforations was successful in all dogs. The mean procedure time for EBL closure with one to three bands was 191.7 seconds, and there were no immediate complications. One animal was euthanized after 3 days because of peritonitis. There were no clinical and laboratory features of sepsis or peritonitis in the remaining six animals. On necropsy, we did not find any fecal peritonitis, pericolonic abscess formation, or transmural dehiscence at the perforation site. Histopathology demonstrated inflamed granulation tissue and scar lesions replaced by fibrosis.
Conclusions
EBL might be a feasible and safe method for the management of iatrogenic colon perforations in an in vivo model.

Citations

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Endoscopic Management of Iatrogenic Colon Perforation
Yunho Jung
Clinical Endoscopy.2020; 53(1): 29. CrossRef
Endoluminal closure of an unrecognized penetrating stab wound of the duodenum with endoscopic band ligation: A case report
Dae Hoon Kim, Hanlim Choi, Ki Bae Kim, Hyo Yung Yun, Joung-Ho Han
World Journal of Clinical Cases.2019; 7(20): 3271. CrossRef
Endoscopic management of iatrogenic gastrointestinal perforations
Kan Wang, Jihao Shi, Linna Ye
Laparoscopic, Endoscopic and Robotic Surgery.2019; 2(2): 41. CrossRef
Endoscopic Band Ligation Is Able to Close Perforations Caused by Colonoscopy: A Porcine Model Study
Yidong Yang, Xianyi Lin, Siwei Tan, Xiaoli Huang, Zijun Xie, Xuan Xu, Yiming Lei, Bin Wu
Gastroenterology Research and Practice.2018; 2018: 1. CrossRef

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Efficacy and Safety of Endoscopic Papillary Balloon Dilation Using Cap-Fitted Forward-Viewing Endoscope in Patients Who Underwent Billroth II Gastrectomy: Jong Soon Jang, Seungho Lee, Hee Seung Lee, Myeong Ho Yeon, Joung-Ho Han, Soon Man Yoon, Hee Bok Chae, Sei Jin Youn, Seon Mee Park; Clin Endosc 2015;48(5):421-427. Published online September 30, 2015; DOI: https://doi.org/10.5946/ce.2015.48.5.421

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Background/Aims

Endoscopic exploration of the common bile duct (CBD) is difficult and dangerous in patients with Billroth II gastrectomy (B-II). Endoscopic papillary balloon dilation (EPBD) via a cap-fitted forward-viewing endoscope has been reported to be an effective and safe procedure. We analyzed the technical success and complications of EPBD in patients who underwent B-II.

Methods

Thirty-six consecutive patients with B-II were enrolled from among 2,378 patients who had undergone endoscopic retrograde cholangiopancreatography in a single institute in the last 4 years. The EPBD procedure was carried out using a cap-fitted forward-viewing endoscope with 8-mm balloon catheters for 60 seconds. We analyzed the rates of CBD exploration, technical success, and complications.

Results

Afferent loop intubation was performed in all patients and selective cannulation of the bile duct was performed in 32 patients (88.9%). Complications such as transient hypoxia were observed in two patients (5.6%) and perforation, in three patients (9.7%). The perforation sites were ductal injury in two patients and one patient showed retroperitoneal air alone without symptoms. Three patients manifested different clinical courses of severe acute pancreatitis and peritonitis, transient abdominal pain, and retroperitoneal air alone. The condition of one patient improved with surgery and that of the other two patients, with conservative management.

Conclusions

Patients with perforation during EPBD in B-II showed different clinical courses. Tailored treatment strategies are necessary for improving the clinical outcomes.

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Endoscopic biliary drainage in patients with surgically altered anatomy: the Street multicenter study
Aurelio Mauro, Giuseppe Vanella, Vincenzo Giorgio Mirante, Alessandro Fugazza, Cecilia Binda, Luca Elli, Edoardo Forti, Roberto Di Mitri, Debora Berretti, Helga Bertani, Mariangela Delliponti, Federico Desideri, Virginia Ferretti, Roberto Grassia, Roberto
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Usefulness of the clip-with-line method for difficult biliary cannulation in Billroth II gastrectomy
Shiyu Ou, Caijie Xu, Zhixin Chen, Zhongzhuan Li, Ling Du
European Journal of Gastroenterology & Hepatology.2026; 38(4): 517. CrossRef
A “One Accessory and One Guidewire-in-One Channel” Technique in a Patient with Billroth II Anastomosis
Kook Hyun Kim, Sung Bum Kim, Tae Nyeun Kim
Clinical Endoscopy.2021; 54(1): 139. CrossRef
Which scope is appropriate for endoscopic retrograde cholangiopancreatography after Billroth II reconstruction: An esophagogastroduodenoscope or a colonoscope?
Mitsuru Sugimoto, Tadayuki Takagi, Rei Suzuki, Naoki Konno, Hiroyuki Asama, Yuki Sato, Hiroki Irie, Ko Watanabe, Jun Nakamura, Hitomi Kikuchi, Mika Takasumi, Minami Hashimoto, Tsunetaka Kato, Takuto Hikichi, Hiromasa Ohira
World Journal of Gastrointestinal Endoscopy.2020; 12(8): 220. CrossRef
Recent advances in endoscopic retrograde cholangiopancreatography in Billroth II gastrectomy patients: A systematic review
Tae Young Park, Tae Jun Song
World Journal of Gastroenterology.2019; 25(24): 3091. CrossRef
Challenges of endoscopic retrograde cholangiopancreatography in patients with Billroth II gastrointestinal anatomy: A review article
Rabbinu Rangga Pribadi, Abdul Aziz Rani, Murdani Abdullah
Journal of Digestive Diseases.2019; 20(12): 631. CrossRef
Endoscopic retrograde cholangiopancreatography in Billroth II gastrectomy patients: Outcomes and potential factors affecting technical failure
Jia-Su Li, Duo-Wu Zou, Zhen-Dong Jin, Jie Chen, Xin-Gang Shi, Zhao-Shen Li, Feng Liu
Saudi Journal of Gastroenterology.2019; 25(6): 355. CrossRef
Endoscopic Management of Difficult Bile Duct Stones
Murad Aburajab, Kulwinder Dua
Current Gastroenterology Reports.2018;[Epub] CrossRef
Forward-viewing endoscope for ERCP in patients with Billroth II gastrectomy: a systematic review and meta-analysis
Tae Young Park, Chang Seok Bang, Sang Hyeon Choi, Young Joo Yang, Suk Pyo Shin, Ki Tae Suk, Gwang Ho Baik, Dong Joon Kim, Jai Hoon Yoon
Surgical Endoscopy.2018; 32(11): 4598. CrossRef
Self-expandable metal stents for choledocholithiasis in Billroth II gastrectomy patients
Min-Gui Han, Eunae Cho, Chang-Hwan Park, Chung-Hwan Jun, Seon-Young Park
Hepatobiliary & Pancreatic Diseases International.2018; 17(6): 546. CrossRef
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Seon Mee Park
Clinical Endoscopy.2016; 49(4): 376. CrossRef

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Case Reports

Delayed Perforation Occurring after Endoscopic Submucosal Dissection for Early Gastric Cancer: Soo Hoon Kang, Kyungho Lee, Hyun Woo Lee, Ga Eun Park, Yun Soo Hong, Byung-Hoon Min; Clin Endosc 2015;48(3):251-255. Published online May 29, 2015; DOI: https://doi.org/10.5946/ce.2015.48.3.251

Abstract PDF PubReader ePub

Delayed perforation is a very rare complication of endoscopic submucosal dissection (ESD), with a reported incidence of 0.1% to 0.45%. Few reports exist on the clinical features and outcomes of delayed perforation after ESD, and it is unclear whether the optimal management strategy is emergency surgery or endoscopic closure with conservative treatment. Here, we report two cases of delayed perforation occurring after ESD for early gastric cancer. In both cases, lesions were located in the antrum, and tumor depths were confined to the mucosal layer. Total procedure times for ESD were 25 and 45 minutes, respectively. Because delayed perforation may be associated with excessive thermal damage and necrosis of the muscle layer, treatment with emergency surgery should be used instead of conservative management in cases of delayed perforation after ESD.

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Analysis of Risk Factors for Postoperative Delayed Perforation Following Endoscopic Submucosal Dissection of Gastrointestinal Stromal Tumors
Chaoshu Guo, Linyun Xue, Guofeng Pan, Sijie Chen, Xiongbo Wu, Suping Li
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques.2026;[Epub] CrossRef
Delayed Perforation After Endoscopic Resection of Upper Gastrointestinal Tumors
Subin Heo, Jimi Huh, Jai Keun Kim, Ki Myung Lee
Journal of Clinical Gastroenterology.2025; 59(6): 542. CrossRef
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Ji Eun Kim, Jeayoun Kim, Tae Se Kim, Yang Won Min, Hyuk Lee, Byung-Hoon Min, Jun Haeng Lee, Poong-Lyul Rhee, Jae J. Kim
Diagnostics.2025; 15(3): 335. CrossRef
Delayed Perforation Occurring after Gastric Endoscopic Submucosal Dissection: Clinical Features and Management Strategy
Tae-Se Kim, Byung-Hoon Min, Yang Won Min, Hyuk Lee, Poong-Lyul Rhee, Jae J. Kim, Jun Haeng Lee
Gut and Liver.2024; 18(1): 40. CrossRef
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Takeshi Uozumi, Seiichiro Abe, Mai Ego Makiguchi, Satoru Nonaka, Haruhisa Suzuki, Shigetaka Yoshinaga, Yutaka Saito
Clinical Endoscopy.2023; 56(4): 409. CrossRef
Novel image enhancement technology that helps find bleeding points during endoscopic submucosal dissection of gastric neoplasms
Kohei Funasaka, Ryoji Miyahara, Noriyuki Horiguchi, Takafumi Omori, Hayato Osaki, Dai Yoshida, Hyuga Yamada, Keishi Koyama, Mitsuo Nagasaka, Yoshiyuki Nakagawa, Senju Hashimoto, Tomoyuki Shibata, Yoshiki Hirooka
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Intestinal Research.2021; 19(2): 127. CrossRef
Endoscopic Resection of Gastric Cancer
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Delayed perforation occurring on the 24th day after endoscopic submucosal dissection for early gastric cancer
Satoru Homma, Kazuaki Tokodai, Minami Watanabe, Kai Takaya, Eiji Hashizume
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Yoshinobu Yamamoto, Hogara Nishisaki, Hideki Sakai, Nagahiro Tokuyama, Hiroaki Sawai, Aya Sakai, Takuya Mimura, Saeko Kushida, Hidetaka Tsumura, Takeshi Sakamoto, Ikuya Miki, Masahiro Tsuda, Hideto Inokuchi
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Esophgeal Perforation and Bilateral Empyema Following Endoscopic EsophyX Transoral Incisionless Fundoplication: Hawa Edriss, Amal El-Bakush, Kenneth Nugent; Clin Endosc 2014;47(6):560-563. Published online November 30, 2014; DOI: https://doi.org/10.5946/ce.2014.47.6.560

Abstract PDF PubReader ePub

Transoral incisionless fundoplication (TIF) has been used for endoscopic treatment of gastroesophageal reflux disease (GERD). TIF using the EsophyX device system (EndoGastric Solutions) was designed to create a full-thickness valve at the gastroesophageal junction through the insertion of multiple fasteners; it improves GERD, reduces proton pump inhibitor use, and improves quality of life. Although TIF is effective in select patients, a significant subset of patients undergoing TIF develop persistent or recurrent GERD symptoms and may need antireflux surgery to control the GERD symptoms. We now report a 48-year-old man with chronic GERD unresponsive to medical management. He underwent TIF complicated by esophageal perforation and developed mediastinitis, left pneumothorax, bilateral pleural effusions, and acute respiratory failure. He required chest tube placement and bilateral decortication for treatment of nonresolving empyemas. Additional postmarketing studies are required to assess the safety, efficacy, and clinical outcomes of this novel procedure, and patients undergoing this procedure need close postprocedural follow-up.

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Anmol Mohan, Faryal Sohail, Namra Asif Saeed, Maryam Jameel, Mazen W. Assal, Zim Warda Hasan, Arfah Zafar, Hasibullah Aminpoor, Vikash Kumar
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Robert A. Ganz, Steven A. Edmundowicz, Paul A. Taiganides, John C. Lipham, C. Daniel Smith, Kenneth R. DeVault, Santiago Horgan, Garth Jacobsen, James D. Luketich, Christopher C. Smith, Steven C. Schlack-Haerer, Shanu N. Kothari, Christy M. Dunst, Thomas
Clinical Gastroenterology and Hepatology.2016; 14(5): 671. CrossRef

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Original Article

Gastric Endoscopic Submucosal Dissection Is Safe for Day Patients: Sun Young Ahn, Sun Ik Jang, Dong Wook Lee, Seong Woo Jeon; Clin Endosc 2014;47(6):538-543. Published online November 30, 2014; DOI: https://doi.org/10.5946/ce.2014.47.6.538

Abstract PDF PubReader ePub

Background/Aims

Although the advantages of endoscopic submucosal dissection (ESD) are well established, there are important limitations that relate to its higher cost and higher rate of complications compared with endoscopic mucosal resection. This study assessed the therapeutic safety and efficacy of ESD in the treatment of small gastric dysplasia and early gastric cancer (EGC) located within the antrum in an outpatient setting, and it compared the results with those from patients admitted to hospital for ESD treatment.

Methods

This study was a retrospective analysis of a prospectively maintained database. We reviewed consecutive patients with EGC or gastric dysplasia who underwent ESD between October 2007 and May 2008. The lesions were smaller than 2 cm and were located in the antrum. We analyzed 105 lesions in 105 patients. The patients were assigned to two groups according to each patient's preference.

Results

The overall rates of complete resection were 98.1% in the inpatients group and 94.3% in the outpatients group. Immediate bleeding occurred in four inpatients, which included one patient in the outpatient group. Delayed bleeding occurred in one inpatient within 24 hours of the procedure. Macroperforations did not occur in either group. A microperforation was found in one outpatient.

Conclusions

The safety and efficacy of ESD used to treat small gastric tumors in the antrum in an outpatient setting appeared to be similar to the safety and efficacy of ESD used to treat patients who were admitted to the hospital.

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Pathology and Clinical Relevance of Gastric Epithelial Dysplasia
Tetsuo Ushiku, Gregory Y. Lauwers
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Outpatient hybrid endoscopic submucosal dissection with SOUTEN for early gastric cancer, followed by endoscopic suturing of the mucosal defect: A case report
Renma Ito, Kazuhiro Miwa, Yutaka Matano
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Endoscopic submucosal dissection of gastrointestinal lesions on an outpatient basis
Francisco Baldaque-Silva, Margarida Marques, Ana Patrícia Andrade, Nuno Sousa, Joanne Lopes, Fatima Carneiro, Guilherme Macedo
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Diogo Libânio, Mariana Nuno Costa, Pedro Pimentel-Nunes, Mário Dinis-Ribeiro
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Gastric dysplasia: update and practical approach
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Complications Related to Gastric Endoscopic Submucosal Dissection and Their Managements: Itaru Saito, Yosuke Tsuji, Yoshiki Sakaguchi, Keiko Niimi, Satoshi Ono, Shinya Kodashima, Nobutake Yamamichi, Mitsuhiro Fujishiro, Kazuhiko Koike; Clin Endosc 2014;47(5):398-403. Published online September 30, 2014; DOI: https://doi.org/10.5946/ce.2014.47.5.398

Abstract PDF PubReader ePub

Endoscopic submucosal dissection (ESD) for early gastric cancer is a well-established procedure with the advantage of resection in an en bloc fashion, regardless of the size, shape, coexisting ulcer, and location of the lesion. However, gastric ESD is a more difficult and meticulous technique, and also requires a longer procedure time, than conventional endoscopic mucosal resection. These factors naturally increase the risk of various complications. The two most common complications accompanying gastric ESD are bleeding and perforation. These complications are known to occur both intraoperatively and postoperatively. However, there are other rare but serious complications related to gastric ESD, including aspiration pneumonia, stenosis, venous thromboembolism, and air embolism. Endoscopists should have sufficient knowledge about such complications and be prepared to deal with them appropriately, as successful management of complications is necessary for the successful completion of the entire ESD procedure.

Citations

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The Management of Endoscopic Retrograde Cholangiopancreatography-Related Duodenal Perforation: Kwang Bum Cho; Clin Endosc 2014;47(4):341-345. Published online July 28, 2014; DOI: https://doi.org/10.5946/ce.2014.47.4.341

Abstract PDF PubReader ePub

Uneventful duodenal perforation during endoscopic retrograde cholangiopancreatography (ERCP) is an uncommon but occasionally fatal complication. ERCP-related perforations may occur during sphincterotomy and improper manipulation of the equipment and scope. Traditionally, duodenal perforation has been treated with early surgical repair. Recently, nonoperative early endoscopic management techniques including clips or fibrin glue have been reported. In the present paper we review the literature pertaining to the treatment of perforations.

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Case Report

An Unusual Case of Duodenal Perforation Caused by a Lollipop Stick: A Case Report: Eun Ae Cho, Du Hyeon Lee, Hyoung Ju Hong, Chang Hwan Park, Seon Young Park, Hyun Soo Kim, Sung Kyu Choi, Jong Sun Rew; Clin Endosc 2014;47(2):188-191. Published online March 31, 2014; DOI: https://doi.org/10.5946/ce.2014.47.2.188

Abstract PDF PubReader ePub

Most ingested foreign bodies often pass through the gastrointestinal tract uneventfully; however, complications such as perforation do occur. Most cases of perforation are caused by thin, pointed objects such as needles, toothpicks, or fish and chicken bones. Herein, we report an unusual case of duodenal perforation caused by a lollipop stick with blunt ends. A 23-year-old woman was admitted to the emergency department complaining of epigastric and right upper quadrant pain for the last 2 days. Abdominal computed tomography scans confirmed the presence of a foreign body in the duodenum, with signs of duodenal perforation and inflammation. The patient was not aware of ingesting the foreign body. Endoscopy revealed the presence of a lollipop stick in the duodenum, which was removed with forceps. The duodenal perforation was successfully managed by using hemoclips and a detachable snare.

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Special Issue Articles of IDEN 2013

Endoscopic Treatments of Endoscopic Retrograde Cholangiopancreatography-Related Duodenal Perforations: Tae Hoon Lee, Joung-Ho Han, Sang-Heum Park; Clin Endosc 2013;46(5):522-528. Published online September 30, 2013; DOI: https://doi.org/10.5946/ce.2013.46.5.522

Abstract PDF PubReader ePub

Iatrogenic duodenal perforation associated with endoscopic retrograde cholangiopancreatography (ERCP) is a very uncommon complication that is often lethal. Perforations during ERCP are caused by endoscopic sphincterotomy, placement of biliary or duodenal stents, guidewire-related causes, and endoscopy itself. In particular, perforation of the medial or lateral duodenal wall usually requires prompt diagnosis and surgical management. Perforation can follow various clinical courses, and management depends on the cause of the perforation. Cases resulting from sphincterotomy or guidewire-induced perforation can be managed by conservative treatment and biliary diversion. The current standard treatment for perforation of the duodenal free wall is early surgical repair. However, several reports of primary endoscopic closure techniques using endoclip, endoloop, or newly developed endoscopic devices have recently been described, even for use in direct perforation of the duodenal wall.

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Colonic Perforation: Can We Manage It Endoscopically?: Jeong-Sik Byeon; Clin Endosc 2013;46(5):495-499. Published online September 30, 2013; DOI: https://doi.org/10.5946/ce.2013.46.5.495

Abstract PDF PubReader ePub

Colonic perforation occurs in a variety of clinical scenarios and colonoscopy-associated perforation is one of the important reasons for colonic perforation. Colonoscopy-associated perforation may be diagnosed during colonoscopy procedure by the visualization of evident colonic wall defect or, after the completion of colonoscopy, by the visualization of leaked air in the peritoneal or retroperitoneal space. Recently, the incidence of colonoscopy-associated perforation increased because of the introduction of colorectal endoscopic submucosal dissection. Traditionally, colonoscopy-associated perforation was managed surgically. However, medical management has been introduced widely and endoscopic clipping is the most important component for the medical management of colonoscopy-associated perforation. Timely administration of antibiotics is also important. Large perforations, diagnostic colonoscopy-associated perforations, large amount of pneumoperitoneum, and severe abdominal pain have been reported to be predictive of the necessity of surgery after endoscopic clipping. Surgery should be performed if patients show clinical deterioration even after the initiation of medical management.

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Original Article

Angular Positioning of Stent Increases Bowel Perforation after Self-Expandable Metal Stent Placement for Malignant Colorectal Obstruction: Jeong Guil Lee, Kwang Ho Yoo, Chang-Il Kwon, Kwang Hyun Ko, Sung Pyo Hong; Clin Endosc 2013;46(4):384-389. Published online July 31, 2013; DOI: https://doi.org/10.5946/ce.2013.46.4.384

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Background/Aims

Some factors like stent wires, balloon dilatation and use of guide wires seems to increase perforation after self-expandable metal stent (SEMS) placement, but few studies mentioned about the relationship between angulation of malignant stricture and perforation. The present study aimed to confirm that more angular positioning of stents increases perforation.

Methods

This study was conducted with retrospectively evaluation at Digestive Disease Center, CHA Bundang Medical Center, CHA University. Between January 2002 and August 2011, SEMS was inserted in 130 patients with malignant colorectal obstruction. We studied the difference in the angle of stenosis between perforation and non-perforation groups using fluorography images.

Results

SEMS insertion was performed in 130 cases of obstruction due to colon cancer. Perforation occurred in eight patients (6.2%) of them. Thirteen cases were excluded from the analysis due to poor fluoroscopic images. Among the eight patients with perforation, the mean stenosis angle was 109.9° compared to 153.1° in the nonperforation group, indicating that the angle was more acute in the perforation group (p=0.016).

Conclusions

This study shows that more angular positioning of stent increases bowel perforation after SEMS placement for malignant colorectal obstruction.

Citations

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Chong-Chi Chiu, Kuo-Chuan Hung, Li-Ren Yeh
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Hiroshi Takeyama, Kotaro Kitani, Tomoko Wakasa, Masanori Tsujie, Yoshinori Fujiwara, Shigeto Mizuno, Masao Yukawa, Yoshio Ohta, Masatoshi Inoue
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Se Hui Oh, Nak Jun Choi, Sang Hyuk Seo, Min Sung An, Kwang Hee Kim, Ki Beom Bae, Jin Won Hwang, Sang Heon Lee, Ji Hyun Kim, Sam Ryong Jee, Mi Seon Kang, Kwan Hee Hong
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Hans-Ulrich Laasch, Derek W. Edwards, Ho-Young Song
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Chen-Wang Chang, Jau-Min Wong, Chien-Chih Tung, I-Lun Shih, Horng-Yuan Wang, Shu-Chen Wei
Intestinal Research.2015; 13(1): 19. CrossRef
Predictive Factors for Successful Colonic Stenting in Acute Large-Bowel Obstruction
Derek J. Boyle, Christopher Thorn, Ashish Saini, Colin Elton, Gary K. Atkin, Ian C. Mitchell, Kevin Lotzof, Adrian Marcus, Pawan Mathur
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Stents for colonic strictures: Materials, designs, and more
Nandakumar Srinivasan, Richard A. Kozarek
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Case Report

A Case of Ampullary Perforation Treated with a Temporally Covered Metal Stent: Woo Young Park, Kwang Bum Cho, Eun Soo Kim, Kyung Sik Park; Clin Endosc 2012;45(2):177-180. Published online June 30, 2012; DOI: https://doi.org/10.5946/ce.2012.45.2.177

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Endoscopic retrograde cholangiopancreatography (ERCP)-related perforation is classified into three or four types based on anatomical location and the mechanism of injury. Although ampullary injury, among them, may be managed nonsurgically, surgical management is required in cases of perforation with retroperitoneal fluid collection and severe condition. Here, a patient with ERCP-related severe ampullary perforation with retroperitoneal fluid collection that was treated nonsurgically with a covered stent is presented.

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Endoscopic Band Ligation in Endoscopic Retrograde Cholangiopancreatography Related Duodenal Perforation
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24 Crossref

Esophageal Perforation after Change of a Percutaneous Endoscopic Gastrostomy Tube: Seong Wook Heo, M.D., Joong Goo Kwon, M.D., Kyoung Chan Park, M.D., Jung Il Ryu, M.D., Dong Uk Ju, M.D., Kyung Ho Ha, M.D., Jin Tae Jung, M.D. and Ho Gak Kim, M.D.; Korean J Gastrointest Endosc 2011;43(1):1-4. Published online July 28, 2011

Abstract PDF: Percutaneous endoscopic gastrostomy (PEG) has become a widely used and safe method for long-term enteral feeding in patients who are unable to tolerate oral feeding. Although a number of complications can occur following PEG placement, most of these complications are not life threatening. Serious complications occur rarely after this procedure and they include peritonitis, visceral perforation, major gastrointestinal bleeding, and necrotizing fasciitis. An esophageal perforation following PEG placement is very rare and predisposing factors include Zenker's or epiphrenic esophageal diverticuli, esophageal strictures, and mass lesions. We recently experienced a case of distal esophageal perforation following a PEG tube change. The predisposing esophageal perforation factor in this case was uncertain, and we successfully treated the patient with surgical intervention. (Korean J Gastrointest Endosc 2011;43:1-4)

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A Case of a Colon Perforation Due to a Soft Rectal Foreign Body: Jeong Hwa Lee, M.D., Sang Bum Kang, M.D., Dong Cheon Ha, M.D., Ki Huyn Kwon, M.D., Seung Woo Lee, M.D., Yeon Soo Kim, M.D., Dong Soo Lee, M.D. and Soon Woo Nam, M.D.; Korean J Gastrointest Endosc 2011;43(1):52-55. Published online July 28, 2011

Abstract PDF: Numerous foreign bodies in the rectum have been reported in the literature. Their removal can be challenging depending on the size and shape of the objects and their anatomical location in the rectum. A 64-year-old man presented to the emergency department after inserting a sausage into his rectum. He had some rectal discomfort and lower abdominal pain. There were no signs of bowel perforation. We attempted to extract the sausage impacted in the recto-sigmoid junction by colonoscopy using a snare and grasping forceps but failed to extract the foreign body. Unfortunately, a colon perforation had occurred, and the sausage was eventually extracted by performing a colostomy at the recto-sigmoid junction with primary repair. We report this case of a soft rectal foreign body impacted in the recto-sigmoid colon complicated by a colon perforation with a literature review. (Korean J Gastrointest Endosc 2011;43:52-55)

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A Case of Stercoral Perforation of Sigmoid Colon Diagnosed by Colonoscopy: Won Jang, M.D., Tae Joo Jeon, M.D., Ran Heo, M.D., Hwa Mi Kang, M.D., Tae-Hoon Oh, M.D., Dong Dae Seo, M.D., Won Chang Shin, M.D. and Hyun-Jung Kim, M.D.^*; Korean J Gastrointest Endosc 2011;42(5):311-314. Published online May 28, 2011

Abstract PDF: Stercoral perforation of the colon is a rare disease. Yet, in recent times, the number of reported cases has increased because of the growing elderly population. Stercoral perforation of the colon usually occurs in the elderly or bedridden patients with chronic constipation. Stercoral perforation may cause a massive hemorrhage or peritonitis. The prognosis of stercoral perforation is poor, as the reported postoperative mortality is 35∼40%. So, early diagnosis and proper treatment are very important for improving survival. However, making an early diagnosis may be difficult because of the nonspecific initial symptoms. We experienced a case of stercoral perforation that was diagnosed by colonoscopy. The defect was in the sigmoid colon, and it was covered with peritoneum. The patient completely recovered after resection and anastomosis of the perforated colon. We report here on this case with a review of the relevant literature. (Korean J Gastrointest Endosc 2011;42:311-314)

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Colonoscopic Perforation During a Diagnostic Colonoscopy: Jeong Ho Kim, M.D., Eun Jung Jeon, M.D., Jun Ho Song, M.D., Sang Hun Lee, M.D., Jin Hwan Jung, M.D., Dae Young Cheung, M.D., Jin Il Kim, M.D., Soo Heon Park, M.D. and Jae Kwang Kim, M.D.; Korean J Gastrointest Endosc 2011;42(5):289-292. Published online May 28, 2011

Abstract PDF

Background/Aims: Colonoscopy is a useful method for detecting colorectal disease, but complications are on the rise due to the increasing number of colonoscopies. The aim of this study was to analyze colon perforations following diagnostic colonoscopies.

Methods: We performed retrospective reviews of all patients with colonoscopic perforations between January 2000 and June 2010.

Results: Of 25,883 diagnostic colonoscopies performed, seven cases of colon perforations were reported. Among those, five cases had an abdominal operation history; the site of perforation was the sigmoid colon in three cases and the rectum in four cases. The manipulation type was forward viewing in three cases and retroflexion in four cases. The time to diagnosis was immediate in six cases and delayed in one case, and treatment was conservative management in three cases and surgical management in four cases.

Conclusions: Special attention is required for patients with a previous abdominal operation and retroflexion. Even after perforations occur, favorable outcomes can be obtained by conservative treatment if the patient's condition is stable, the bowel preparation is proper, and there are no signs of peritonitis. (Korean J Gastrointest Endosc 2011;42:289-292)

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Case Reports

A Bowel Perforation That Developed during the Transanal Extraction of a Large Rectal Foreign Body: Keun-Suk Yang, M.D., Joung-Ho Han, M.D.^*, Sunyoung Kim, M.D., Woo Hyung Choi, M.D., Hong-Soon Jung, M.D., Eun Chung, M.D., HyenJeong Jeon, M.D.^* and Seijin Youn, M.D.^*; Korean J Gastrointest Endosc 2011;42(6):406-409. Published online May 25, 2011

Abstract PDF: Rectal foreign bodies are rare clinical problem in South Korea. Although many foreign bodies can be extracted safely using endoscopic procedures, some patients require surgery. Here we describe the case of a 35-year-old male who presented with a rectosigmoid foreign body, a large carrot measuring 28×7 cm. Sigmoidoscopy revealed a carrot in the upper rectum extending to the sigmoid colon. Endoscopic removal failed. The surgeon unsuccessfully attempted to extract the carrot using various tools without spinal anesthesia. During the extraction attempt, the patient complained of sudden abdominal pain, and a simple x-ray revealed pneumoperitoneum. An emergency colotomy and removal of the foreign body was performed, followed by primary repair of the perforation and a colostomy. Three months later, the colostomy was repaired.

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A Primary Repair with Hemoclips and Fibrin Glue Injection in Biliary Stent Induced Duodenal Perforation: Ki Won Kim, M.D., Tae Hoon Lee, M.D., Sang-Heum Park, M.D., Bum Suk Son, M.D., Sae Hwan Lee, M.D., Suck-Ho Lee, M.D., Il-Kwun Chung, M.D. and Sun-Joo Kim, M.D.; Korean J Gastrointest Endosc 2011;42(6):437-441. Published online May 25, 2011

Abstract PDF: Duodenal perforations caused by biliary prostheses are uncommon, but they are potentially life threatening and require immediate treatment. Here we describe an unusual case of duodenal perforation induced by a plastic biliary stent. It masqueraded as a case of cholecystitis and combined systemic upset with a localized peritonitis and fever. Primary endoscopic closure by hemoclips was difficult due to the position of the lateral wall and the complexity of aligning the perforation with the endoscope. To approximate the perforated hole and adherent hemoclips, glue injection and sprayings were successfully performed under cap-fitted endoscopy. The patient recovered without additional complications.

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A Case of Acute Cholecystitis with a Perforation Complicating Endoscopic Retrograde Cholangiopancreatography: Seung Hee Ryu, M.D., Myung Hwan Noh, M.D., Ji Sun Han, M.D., Su Mi Woo, M.D., Byung Geun Kim, M.D., Chien Ter Hsing, M.D., So Young Park, M.D. and Joon Mo Kim, M.D.; Korean J Gastrointest Endosc 2011;42(3):185-189. Published online March 28, 2011

Abstract PDF: The incidence of acute cholecystitis complicating endoscopic retrograde Cholangiopancreatography (ERCP) is rarely reported at 0.2% but is usually associated with a cystic duct obstruction caused by gallstones, gallbladder polyps, or cancer. However, acute cholecystitis with a gallbladder perforation after ERCP without a history of cystic duct obstruction can develop very rarely and has not yet been reported in Korea. We report a case of acute cholecystitis with gallbladder perforation and aggravation of a pancreatic pseudocyst after diagnostic ERCP in a man with a pancreatic cystic lesion. He has been successfully cured using only percutaneous transhepatic gallbladder drainage and antibiotics with no surgery. (Korean J Gastrointest Endosc 2011;42:185-189)

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Management of Duodenal Perforations after Endoscopic Retrograde Cholangiopancreatography: Jong-Hyun Kim, M.D., Keon-Young Lee, M.D., Seung-Ik Ahn, M.D., Kee Chun Hong, M.D., Seok Jung, M.D.*, Don Haeng Lee, M.D.*, Yun-Mee Choe, M.D., Sun Keun Choi, M.D., Yoon-Seok Hur, M.D., Sei Joong Kim, M.D., Young Up Cho, M.D., Seok-Hwan Shin, M.D. and Kyu; Korean J Gastrointest Endosc 2011;42(2):83-89. Published online February 28, 2011

Abstract PDF

Background/Aims: Surgery has been the mainstay of treatment for duodenal perforations after the introduction of endoscopic retrograde cholangiopancreatography (ERCP). Yet there have recently been arguments that conservative management with or without endoscopic intervention may be possible and safe.

Methods: For the patients who received ERCP at Inha University Hospital from Jan. 2001 to Dec. 2007, we retrospectively analyzed the clinical manifestations, the treatment and the clinical outcomes of the cases with duodenal perforation. Results: Among the 1708 ERCP cases, duodenal perforation occurred in eleven (0.6%) patients. There were two cases of duodenal perforations (type I), four cases of peri-Vaterian injury (type II), two cases of bile duct perforations (type III) and three cases of retroperitoneal perforations (type IV). Six patients (55%) were treated surgically while the others were managed conservatively. Except for one death (9.1%), ten patients fully recovered. Either residual diseases or fluid collections, as seen on CT, were present in the surgically managed patients. The median time interval between ERCP and surgery was 19 hours (range: 8∼30 hours).

Conclusions: To decide on the management of duodenal perforation after ERCP, the presence of residual disease or the leakage of intraluminal contents should be considered along with the type of the perforation. (Korean J Gastrointest Endosc 2011;42:83-89)

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Three Cases of Successful Treatment of Iatrogenic Duodenal Perforation: Choong Heon Ryu, M.D., Do Hyun Park, M.D., Myung-Hwan Kim, M.D., Dong Wan Seo, M.D., Sang Soo Lee, M.D., Sung Koo Lee, M.D. and Hong Jun Kim, M.D.; Korean J Gastrointest Endosc 2011;42(1):57-61. Published online January 30, 2011

Abstract PDF: Endoscopic retrograde cholangiopancreatography has become a standard procedure for the diagnosis and treatment of pancreatobiliary disease. Like any invasive procedure, it carries a small, but significant rate of serious complications such as duodenal perforation. Primary surgical closure is the treatment of choice for the cases of duodenal perforation. However, there have been some case reports in which endoscopic metal clip closure of an iatrogenic duodenal perforation was successful. We experienced three cases of successful treatment of the iatrogenic duodenal perforation using endoscopic clipping and fibrin glue injections during a duodenoscope insertion. (Korean J Gastrointest Endosc 2011;42:57-61)

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Pneumothorax, Pneumomediastinum, Subcutaneous Emphysema, Pneumoretroperitoneum Secondary to Colonoscopic Perforation: Ju Kyeon Yim, M.D., Yeong Muk Kim, M.D. and Sung Nam Park, M.D.; Korean J Gastrointest Endosc 2011;42(1):38-42. Published online January 30, 2011

Abstract PDF: A colonoscopic perforation is rare but can cause a fatal outcome. A perforation can be intraperitoneal or retroperitoneal. Air in the retroperitoneal space by perforation can spread to the mediastinum, pleura, and subcutaneous tissue through the visceral space. Therefore, a colonoscopic perforation may manifest as a pneumomediastinum, a pneumothorax, or subcutaneous emphysema without a peritoneal irritation sign. Although a colonoscopic perforation is treated mainly with an operation, medical treatment may be possible in selected cases, especially for a perforation to the retroperitoneal area or that under peritoneal reflexion. Clipping of a perforation is effective for medical treatment. We experienced a case of pneumothorax, pneumomediastinum, subcutaneous emphysema and pneumoretroperitoneum without peritoneal irritation following a diagnostic colonoscopy, which was diagnosed after 3 days because of atypical symptoms but was successfully managed with medical treatment and clipping. (Korean J Gastrointest Endosc 2011;42:38-42)

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Cytomegalovirus Colitis Causing Cecal Perforation and Massive Lower Gastrointestinal Bleeding: Jung Won Jeon, M.D., Jae Myung Cha, M.D., Joung Il Lee, M.D., Kwang Ro Joo, M.D., Hyun Phil Shin, M.D., Jae Jun Park, M.D., Kwan Mi Pack, M.D. and Jun Uk Lim, M.D.; Korean J Gastrointest Endosc 2011;42(1):33-37. Published online January 30, 2011

Abstract PDF: Cytomegalovirus (CMV) infection is associated with significant morbidity and mortality in immunocompromised patients. It may cause serious illness including bleeding, ulceration and perforation of the gastrointestinal tract. However, bowel perforation, toxic megacolon, and massive lower gastrointestinal bleeding caused by CMV in one patient is not common. In this report, we present a case of CMV colitis causing cecal perforation and massive lower gastrointestinal bleeding in a patient with lupus nephritis. In our case, severe lower gastrointestinal bleeding developed during successful treatment of CMV infection with ganciclovir. Even though the outcome of CMV colitis has improved since ganciclovir has been available for immunocompromised patients, reductions in gastrointestinal bleeding from colonic ulcers of CMV colitis may be possible during successful treatment with ganciclovir. This case suggests the possibility of lower gastrointestinal bleeding from a colon ulcer of CMV colitis should be considered during successful treatment with ganciclovir in immunocompromised patients. (Korean J Gastrointest Endosc 2011;42:33-37)

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