Perspectives in Colonoscopy Perforation During Gastroenterology Fellowship

Diagnostic and therapeutic colonoscopy represents one of the mandatory skillsets of gastroenterology (GI) training. This is typically done in a step-up fashion of learning basic (e.g., colonic navigation, prevention of looping), intermediate (e.g., forceps biopsy, basic polypectomy), and advanced techniques (e.g., large polyp resection).1 At any point during the training process, complications can develop, and colonic perforation still stands as the most disruptive complication for patients, families, and healthcare professionals, with reported mortality rates of up to 5%.2 While feared by trainees, colonoscopy perforations are rare and may not even occur during a 3-year GI fellowship. Several studies have shown that the risk of perforation is 1:1,400 for diagnostic and 1:1,000 for therapeutic colonoscopy.2 Therefore, a trainee who performs 400–500 colonoscopies has approximately 1:2 to 1:3 odds of encountering a colonic perforation during training. These estimates may be higher in trainees exposed to endoscopic mucosal resection (EMR) or submusosal dissection (ESD), which carry perforation risk of 1% and 5%, respectively.