Delayed perforation after colonic endoscopic resection has been thought to be fatal and could lead to serious adverse events. However, with the development of endoscopic techniques, endoscopic intervention may avoid the need for emergency surgery. To validate the feasibility of aggressive endoscopic intervention for delayed perforation after colonic endoscopic resection.

Three cases with delayed perforation experienced from April 2023 to March 2024 were enrolled in this retrospective case series. Patients’ backgrounds, procedure-related factors, and outcomes were extracted from medical records, and the feasibility of intensive endoscopic intervention was assessed.

The median age of the patients was 34 (range 15-49). Two of them were male. Two of them underwent endoscopic submucosal dissection (ESD) and one underwater endoscopic mucosal resection (UEMR). The median tumor size is 27mm (range 20 –33mm). The treated sites were sigmoid in two cases and the transverse colon in one.  The median time to delayed perforation after endoscopic resection was 57 hours (range 20-69). All of them had no apparent perforation during endoscopic resection and showed severe abdominal pain and free air on abdominal CT, and no findings of peritonitis or septic shock. Emergency colonoscopy under sedation using midazolam and opioid analgesics was performed for all cases. The perforation site was confirmed endoscopically in two cases. One delayed perforation was closed with endo-clips, and the other two perforations were covered with polyglycolic acid sheets. Diet was resumed at a median of 9 (range 4-13) days after the aggressive endoscopic intervention.

Aggressive endoscopic intervention may be feasible for delayed perforation after colonic endoscopic resection, although an appropriate patients selection would be mandatory.