Video Tip: Perforations and Bleeding in Diagnostic Procedures | June2021-Perforations and Bleeding in Diagnostic Procedures

Video Transcription

Now, perforation, I put it in red because it's always quite a stressful situation. So perforation for diagnostic colonoscopy is extremely rare, 0.3% to 0.01%.  And of course, increased with therapeutic procedure. So how does perforation happen with diagnostic procedure?  First of all, when you try to pass the corners of the colon or part of when a colon is quite angulated and you try to pass it, pushing blindly, so push the scope through the wall  and you can see that the wall change coloration. It goes from a pink color to a white color. That's very unsafe because you are basically applying pressure on the colonic wall.  And this can result in perforation. Ovarian sufflation and bariotrauma can cause perforation. So if you see that the colonic wall is start bleeding and there are some scratches, it  means that there is too much gas inside the bowel. Now, we're now using CO2. So this is very rare events, but because before with the oxygen, it happened more often.  But still, if you see that this is happening in the patient's pain, then you want probably to suck the CO2 and reduce the tension.  And also, when you pass through the channel, the devices, sometimes we do it very quickly and then it happens that the device comes out from the tip of the scope very quickly  and might traumatize the colonic wall, leading to a perforation. It's very rare and extreme perforation. But we always have to take care of these things.  For the gastroscopy, the perforation is even more uncommon than for colonoscopy. Perforation rate is one out of 2,500 to 11,000, based on the literature.  And the predisposing factor are mostly zanker diverticulum or anterior cervical osteophytes or stricture. Bleeding is, again, a very rare adverse event during diagnostic endoscopy.  It's mainly caused in upper GI endoscopy by malaria-wise or a patient with thrombocytopenia or coagulopathies.

Video Summary

In this video, the speaker discusses the rare occurrence of perforation during diagnostic colonoscopy, which happens in 0.3% to 0.01% of cases. Perforation can occur when attempting to pass through the corners or angulated parts of the colon, applying pressure to the colonic wall and causing it to change color. Ovarian sufflation, bariotrauma, and excessive gas inside the bowel can also lead to perforation. The use of CO2 during the procedure has reduced the occurrence of perforation. For gastroscopy, the perforation rate is even lower than colonoscopy, occurring in one out of 2,500 to 11,000 cases, mainly due to conditions such as zanker diverticulum or anterior cervical osteophytes. Bleeding during diagnostic endoscopy is rare and often caused by conditions like malaria-wise or thrombocytopenia.

Keywords

perforation

colonoscopy

diagnostic

CO2

gastroscopy