Therapeutic options for iatrogenic colon perforation: feasibility of endoscopic clip closure and predictors of the need for early surgery

The therapeutic methods of iatrogenic colon perforation have not been performed despite the increasing rates of successful management by endoscopic clip closure. This study aimed to analyze the efficacy and complications of endoscopic clip closure and to identify the risk factors associated with the need for early surgery to avoid more invasive surgical interventions and adverse complications after endoscopic clip closure for iatrogenic colon perforation. A retrospective multicenter review of the clinical course experienced by 32 patients with iatrogenic colon perforation who were treated using immediate endoscopic clip closure between January 2005 and December 2009 was performed. The technical success rate for endoscopic clip closure was 91% (29/32). After endoscopic clip closure, 22 patients (76%) required medical treatment for colon perforation, and seven patients (24%) had surgical treatment. Of the 22 patients who had only endoscopic clip closure, 17 (59%) had a favorable clinical course. Five patients had a long hospital stay with complication including abscess formation (three cases). Four patients underwent early surgery within 24 h, and laparoscopic simple closure was possible. But for three patients with surgery delayed more than 48 h, open laparotomy with colon resection including diversion were required. The risk factors associated with the need for early surgical treatment within 24 h after endoscopic clip closure were a large perforation [odds ratio (OR), 9.25; 95% confidence interval (CI), 1.85-46.20], leukocytosis (OR 6.58; 95% CI 1.86-23.29), fever (OR 5.05; 95% CI 1.05-24.28), severe abdominal pain (OR 4.30; 95% CI 1.17-15.83), and a large amount of peritoneal free air (OR 4.05; 95% CI 1.40-11.71). The endoscopic clip closure procedure can significantly reduce the frequency of surgery among patients with iatrogenic colon perforations. However, the decision for surgery must be made early after endoscopic clip closure to prevent adverse complications for patients with higher risk factors.