Perforation upon retroflexion: an endoscopic complication and repair

Expert opinions and scientific evidence for colonoscopy key performance indicators

Colonoscopy is a widely performed procedure with procedural volumes increasing annually throughout the world. Many procedures are now performed as part of colorectal cancer screening programmes. Colonoscopy should be of high quality and measures of this quality should be evidence based. New UK key performance indicators and quality assurance standards have been developed by a working group with consensus agreement on each standard reached. This paper reviews the scientific basis for each of the quality measures published in the UK standards.

Retroview colonoscopy

A retroview in the colon permits an 11-25% increase in the adenoma detection rate when compared with a standard straight forward view during colonoscopy. This can often be accomplished in the rectum or the proximal colon by using dial controls and shaft manipulation to turn the tip of a standard colonoscope 180°. A special slim caliber instrument, the "Third Eye Retroscope" (a backward viewing device) has been developed which is inserted through the working channel of a colonoscope. New colonoscopes are being developed that have the capability of side vision with accompanying light illumination which, with wide angle lenses, provide an almost complete retroview of the colon.

Tulip bundle technique and fibrin glue injection: Unusual treatment of colonic perforation

We report a case of a 63-year-old male who experienced an iatrogenic sigmoid perforation repaired combining three endoscopic techniques. The lesion was large and irregular with three discrete perforations, therefore, we decided to close it by placing one clip per perforation, and then connecting all the clips with two endoloops. Finally we chose to use a fibrin glue injection to obtain a complete sealing. Four days after the colonoscopy the patient underwent a laparoscopic right hemicolectomy due to evidence of a large polyp of the caecum with high grade dysplasia and focal carcinoma in situ. Inspection of the sigma showed complete repair of the perforation. This report underlines how a conservative approach, together with a combination of various endoscopic techniques, can resolve complicated iatrogenic perforations of the colon.