2017 WSES guidelines for the management of iatrogenic colonoscopy perforation

Nicola de’Angelis, Salomone Di Saverio, Osvaldo Chiara, Massimo Sartelli, Aleix Martínez-Pérez, Franca Patrizi, Dieter G. Weber, Luca Ansaloni, Walter Biffl, Offir Ben-Ishay, Miklosh Bala, Francesco Brunetti, Federica Gaiani, Solafah Abdalla, Aurelien Amiot, Hany Bahouth, Giorgio Bianchi, Daniel Casanova, Federico Coccolini, Raul Coimbra, Gian Luigi de’Angelis, Belinda De Simone, Gustavo P. Fraga, Pietro Genova, Rao Ivatury, Jeffry L. Kashuk, Andrew W. Kirkpatrick, Yann Le Baleur, Fernando Machado, Gustavo M. Machain, Ronald V. Maier, Alain Chichom-Mefire, Riccardo Memeo, Carlos Mesquita, Juan Carlos Salamea Molina, Massimiliano Mutignani, Ramiro Manzano-Núñez, Carlos Ordoñez, Andrew B. Peitzman, Bruno M. Pereira, Edoardo Picetti, Michele Pisano, Juan Carlos Puyana, Sandro Rizoli, Mohammed Siddiqui, Iradj Sobhani, Richard P. ten Broek, Luigi Zorcolo, Maria Clotilde Carra, Yoram Kluger, Fausto Catena

Iatrogenic colonoscopy perforation (ICP) is a severe complication that can occur during both diagnostic and therapeutic procedures. Although 45-60% of ICPs are diagnosed by the endoscopist while performing the colonoscopy, many ICPs are not immediately recognized but are instead suspected on the basis of clinical signs and symptoms that occur after the endoscopic procedure. There are three main therapeutic options for ICPs: endoscopic repair, conservative therapy, and surgery. The therapeutic approach must vary based on the setting of the diagnosis (intra- or post-colonoscopy), the type of ICP, the characteristics and general status of the patient, the operator's level of experience, and surgical device availability. Although ICPs have been the focus of numerous publications, no guidelines have been created to standardize the management of ICPs. The aim of this article is to present the World Society of Emergency Surgery (WSES) guidelines for the management of ICP, which are intended to be used as a tool to promote global standards of care in case of ICP. These guidelines are not meant to substitute providers' clinical judgment for individual patients, and they may need to be modified based on the medical team's level of experience and the availability of local resources.