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Clinical outcomes and direct costings of endoluminal clipping compared to surgery in the management of iatrogenic colonic perforation
Author(s) -
Chan WahKheong,
Roslani April Camilla,
Law CheeWei,
Goh KheanLee,
Mahadeva Sanjiv
Publication year - 2013
Publication title -
journal of digestive diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 51
eISSN - 1751-2980
pISSN - 1751-2972
DOI - 10.1111/1751-2980.12097
Subject(s) - medicine , clipping (morphology) , perforation , surgery , retrospective cohort study , single center , philosophy , linguistics , materials science , punching , metallurgy
Objective To compare the outcomes and costs of endoluminal clipping and surgery in the management of iatrogenic colonic perforation. Methods A retrospective, single‐center, clinical and economic analysis of outcomes and costings between endoluminal clipping and surgery in consecutive cases of iatrogenic colonic perforations was conducted. Results In total, 7136 colonoscopies performed over a 6‐year period were complicated by 12 (0.17%) perforations. Seven cases were treated by endoscopic clipping (with a success rate of 71.4%) and five with immediate surgery. Both groups of patients had similar clinical and individual characteristics. Patients who were treated with endoscopic clipping had a shorter period of hospitalization (median 9 vs 13 days) compared to surgery, but this was not statistically significant. Compared to patients who had immediate surgery, the median direct health‐care costs for all procedures ( US $ 115.10 vs US $ 1479.50, P = 0.012) and investigations ( US $ 124.60 vs US $ 512.90, P = 0.048) during inpatient stay were lower for the endoscopic clipping group. There was a trend towards a lower overall inpatient median cost for patients managed with endoscopic clipping compared to surgery ( US $ 1481.70 vs US $ 3281.90, P = 0.073). Conclusion Endoluminal clipping may be more cost‐effective than surgery in the management of iatrogenic colonic perforations.