Tawheed A, Bahcecioglu IH, Yalniz M, Ozercan M, Oral AC, El-Kassas M. Summary of the current guidelines for managing iatrogenic colorectal perforations and the evolving role of endoluminal vacuum therapy. World J Clin Cases 2025; 13(6): 97545 [DOI: 10.12998/wjcc.v13.i6.97545]
Corresponding Author of This Article
Mohamed El-Kassas, MD, Full Professor, Department of Endemic Medicine, Faculty of Medicine, Helwan University, Ain Helwan, Cairo 11795, Egypt. m_elkassas@yahoo.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Editorial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Feb 26, 2025; 13(6): 97545 Published online Feb 26, 2025. doi: 10.12998/wjcc.v13.i6.97545
Summary of the current guidelines for managing iatrogenic colorectal perforations and the evolving role of endoluminal vacuum therapy
Ahmed Tawheed, Ibrahim Halil Bahcecioglu, Mehmet Yalniz, Mubin Ozercan, Ali Cagri Oral, Mohamed El-Kassas
Ahmed Tawheed, Mohamed El-Kassas, Department of Endemic Medicine, Faculty of Medicine, Helwan University, Cairo 11795, Egypt
Ibrahim Halil Bahcecioglu, Mehmet Yalniz, Mubin Ozercan, Ali Cagri Oral, Department of Gastroenterology, Firat University, Elazig 23119, Türkiye
Mohamed El-Kassas, Liver Disease Research Center, College of Medicine, King Saud University, Riyadh 7805, Saudi Arabia
Author contributions: All authors contributed to this article and approved the final version of the manuscript. El-Kassas M designed the overall concept and outline of the manuscript; Tawheed A, and Ozercan M wrote the manuscript; Oral AC searched the literature; Yalniz M revised the manuscript; Bahcecioglu IH provided critical technical points to the manuscript and the management algorithm.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mohamed El-Kassas, MD, Full Professor, Department of Endemic Medicine, Faculty of Medicine, Helwan University, Ain Helwan, Cairo 11795, Egypt. m_elkassas@yahoo.com
Received: June 1, 2024 Revised: October 30, 2024 Accepted: November 12, 2024 Published online: February 26, 2025 Processing time: 176 Days and 15.5 Hours
Abstract
Colonoscopy represents a safe procedure that is widely used in medical practice either to diagnose or treat various gastrointestinal diseases. During the last few years, the incidence rate of perforations in colonoscopic procedures has increased, especially in therapeutic colonoscopies. The recent advancements in endoscopic techniques and gastrointestinal tumoral resection procedures such as endoscopic mucosal resection, endoscopic full-thickness resection, and endoscopic submucosal dissection (ESD) could be a risk factor for this increased risk. The incidence rate of mortality of serious colonoscopic perforations is 7.1%. The management plan for these perforations starts with conservative treatment in mild cases, endoscopic closure, and surgical management in severe cases. Recently, endoluminal vacuum therapy was found to be effective in the management of colorectal perforations and this has been reported in multiple case reports. This editorial provides an overview of the current guidelines for the management of iatrogenic colorectal perforations. These insights are from the perspectives of endoscopists and gastroenterologists. We also present a management algorithm based on the guidelines of the European Society of Gastrointestinal Endoscopy, the American Gastroenterological Association, and the World Society of Emergency Surgery. We also discussed in brief the use of endoluminal vacuum therapy in colorectal perforations.
Core Tip: In this editorial, we summarize the different current society guidelines and evidence for the management of iatrogenic colorectal perforation, emphasizing the role of endoscopy in perforation management.
