Abstract：
UNASSIGNED: Diagnostic colonoscopy plays a central role in colorectal cancer screening programs. We analyzed the risk factors for perforation during diagnostic colonoscopy and discussed the treatment outcomes.
UNASSIGNED: We performed a retrospective analysis of risk factors and treatment outcomes of perforation during 74,426 diagnostic colonoscopies between 2013 and 2018 in a tertiary hospital.
UNASSIGNED: A total of 19 perforations were identified after 74,426 diagnostic colonoscopies or sigmoidoscopies, resulting in a standardized incidence rate of 0.025% or 2.5 per 10,000 colonoscopies. The majority (15 out of 19, 79%) were found at the sigmoid colon and recto-sigmoid junction. Perforation occurred mostly in less than 1000 cases of colonoscopy (16 out of 19, 84%). In particular, the incidence of perforation was higher in more than 200 cases undergoing slightly advanced colonoscopy rather than beginners who had just learned colonoscopy. Old age (≥ 70 years), inpatient setting, low body mass index (BMI), and sedation status were significantly associated with increased risk of perforation. Nine (47%) of the patients underwent operative treatment and ten (53%) were managed non-operatively. Patients who underwent surgery were often diagnosed with delayed or concomitant abdominal pain. Perforations of rectum tended to be successfully treated with endoscopic clipping.
UNASSIGNED: Additional precautions are required to prevent perforation in elderly patients, hospital settings, low BMI, sedated patients, or by a doctor with slight familiarity with endoscopies (but still insufficient experience). Endoscopic treatment should be actively considered if diagnosis is prompt, abdominal pain absent, and especially the rectal perforation is present.
UNASSIGNED: We performed a retrospective analysis of risk factors and treatment outcomes of perforation during 74,426 diagnostic colonoscopies between 2013 and 2018 in a tertiary hospital.
UNASSIGNED: A total of 19 perforations were identified after 74,426 diagnostic colonoscopies or sigmoidoscopies, resulting in a standardized incidence rate of 0.025% or 2.5 per 10,000 colonoscopies. The majority (15 out of 19, 79%) were found at the sigmoid colon and recto-sigmoid junction. Perforation occurred mostly in less than 1000 cases of colonoscopy (16 out of 19, 84%). In particular, the incidence of perforation was higher in more than 200 cases undergoing slightly advanced colonoscopy rather than beginners who had just learned colonoscopy. Old age (≥ 70 years), inpatient setting, low body mass index (BMI), and sedation status were significantly associated with increased risk of perforation. Nine (47%) of the patients underwent operative treatment and ten (53%) were managed non-operatively. Patients who underwent surgery were often diagnosed with delayed or concomitant abdominal pain. Perforations of rectum tended to be successfully treated with endoscopic clipping.
UNASSIGNED: Additional precautions are required to prevent perforation in elderly patients, hospital settings, low BMI, sedated patients, or by a doctor with slight familiarity with endoscopies (but still insufficient experience). Endoscopic treatment should be actively considered if diagnosis is prompt, abdominal pain absent, and especially the rectal perforation is present.
摘要：
■诊断性结肠镜检查在结直肠癌筛查计划中起着核心作用。我们分析了诊断性结肠镜检查中穿孔的危险因素，并讨论了治疗结果。
■我们对2013年至2018年在三级医院进行的74,426例诊断性结肠镜检查中穿孔的危险因素和治疗结果进行了回顾性分析。
■在进行74,426次诊断性结肠镜检查或乙状结肠镜检查后，共发现19个穿孔，导致每10,000次结肠镜检查的标准化发病率为0.025％或2.5。在乙状结肠和直肠-乙状结肠连接处发现了大多数（19个中的15个，占79％）。穿孔主要发生在少于1000例结肠镜检查中（19例中的16例，84％）。特别是,在200多例接受稍微高级结肠镜检查的患者中,穿孔的发生率高于刚学会结肠镜检查的初学者.高龄（≥70岁），住院设置，低体重指数（BMI），镇静状态与穿孔风险增加显著相关.9例（47％）的患者接受了手术治疗，10例（53％）的患者接受了非手术治疗。接受手术的患者通常被诊断为延迟或伴有腹痛。直肠穿孔倾向于通过内窥镜夹闭成功治疗。
■需要采取额外的预防措施来防止老年患者穿孔，医院设置，低BMI,镇静病人,或由医生对内窥镜检查略有熟悉（但经验仍然不足）。如果诊断迅速，应积极考虑内镜治疗。没有腹痛，尤其是直肠穿孔。
■我们对2013年至2018年在三级医院进行的74,426例诊断性结肠镜检查中穿孔的危险因素和治疗结果进行了回顾性分析。
■在进行74,426次诊断性结肠镜检查或乙状结肠镜检查后，共发现19个穿孔，导致每10,000次结肠镜检查的标准化发病率为0.025％或2.5。在乙状结肠和直肠-乙状结肠连接处发现了大多数（19个中的15个，占79％）。穿孔主要发生在少于1000例结肠镜检查中（19例中的16例，84％）。特别是,在200多例接受稍微高级结肠镜检查的患者中,穿孔的发生率高于刚学会结肠镜检查的初学者.高龄（≥70岁），住院设置，低体重指数（BMI），镇静状态与穿孔风险增加显著相关.9例（47％）的患者接受了手术治疗，10例（53％）的患者接受了非手术治疗。接受手术的患者通常被诊断为延迟或伴有腹痛。直肠穿孔倾向于通过内窥镜夹闭成功治疗。
■需要采取额外的预防措施来防止老年患者穿孔，医院设置，低BMI,镇静病人,或由医生对内窥镜检查略有熟悉（但经验仍然不足）。如果诊断迅速，应积极考虑内镜治疗。没有腹痛，尤其是直肠穿孔。
