Colonic Wall Injuries after Endoscopic Resection: Still A Major Complication? A Retrospective Analysis of 3782 Endoscopic Resections.

Background Colonic wall injuries are the most feared adverse events of endoscopic resections among endoscopists. The implementation of endoscopic closure has offered a reliable way to treat such injuries and thus decreased their overall morbidity and mortality. Objectives The aim of our study is to assess the characteristics and outcomes of colonic wall injuries after endoscopic resection, focusing on their endoscopic treatment. Design This was a retrospective cohort study. Settings Patients treated in the Central Endoscopy Unit of the Medical Centre Mannheim were included. Patients We retrospectively analyzed all patients who underwent endoscopic mucosal resection and snare polypectomy in our center between 2004 and 2019 and isolated the resection-related colonic wall injuries. These were divided into three groups: Group A: endoscopically treated early colonic wall injuries; Group B: non-endoscopically treated early colonic wall injuries; and Group C: late perforations. Main outcome measures Periprocedural factors and treatment outcomes were analyzed and compared among the three groups. Results Out of 3782 endoscopic resections we identified 177 cases of colonic wall injuries, of which 148 were identified and treated endoscopically (Group A), 9 were identified during the procedure but could not be treated endoscopically (Group B) and 20 were late perforations (Group C). Endoscopic treatment with use of clips had a technical success rate of 94.3%, while the clinical success rate of technically complete endoscopic closure was 92.6%. Twenty-two percent of all colonic wall injuries required surgical treatment; the type and outcomes of surgery were the same in all groups. Overall hospital stay was significantly lower in group A. Limitations The main limitation of the study is its retrospective design. Conclusions Endoscopic closure with the use of clips is a safe and feasible treatment for intraprocedurally identified colonic wall injuries and is associated with significantly decreased necessity of surgery, morbidity and hospital stay. See Video Abstract at http://links.lww.com/DCR/B755.