Introduction Iatrogenic perforation is a rare but serious complication of colonoscopy. Reported incidence varies between 0.005% and 0.629%, and is mostly based on diagnostic and therapeutic rather than screening colonoscopies. The British Society of Gastroenterology (BSG) has set a target of no more than one perforation in every 1000 screening colonoscopies.
Method All cases of iatrogenic perforations within the Bowel Screening Wales programme between January 2009 and December 2014 were identified. As part of a robust Quality Assurance programme, a policy of detailed root cause analysis was introduced in 2011; this was subsequently performed for all cases and outcomes recorded.
Results 17,699 screening colonoscopies were performed within the specified time period, of which 10,688 proceeded to polypectomy (60.4%). There were 13 perforations (0.073%), of which 11 underwent root cause analysis. Of these, nine cases were following polypectomy, one was following negotiation around a splenic flexure malignant tumour and one was during a difficult colonoscopy in the context of multiple adhesions and diverticular disease. Almost all were managed with emergency surgery (n = 10). There was one fatality as a result of colonoscopy (0.006%).
Conclusion Our perforation rate falls well below the BSG target and is lower than most of the previously published rates for therapeutic and diagnostic colonoscopies. Management of perforations tends to be less conservative than expected, and this was addressed with individual feedback, education and training. Bowel screening is a safe procedure with a low rate of perforation and a low risk of morbidity and mortality.
Disclosure of interest None Declared.
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