Data source This study was a retrospective analysis to review all lawsuit cases of
colon perforation during colonoscopy using the Court Records of the
Republic of Korea ruled from January 2005 to December 2015. We used the
keyword of ’colonoscopy’ in the ‘Written Judgment Public Reading System’
provided by the Supreme Court. The courts provided us with the copies of
the written judgements deleted personal information. Among the written
judgments we collected, the following types of cases were excluded; 1)
non-colonoscopy cases, 2) non-perforation cases, 3) non-colon
perforation, or 4) cases with insufficient clinical information. When an
appeal was made on a case, only the final judgment was included in this
study.Study designThe written judgments were reviewed
and assessed by two researchers (HM Oh and SH Shin), independently. If
the assessments of the two researchers were divergent, they tried to
reach common ground through discussion, and if an agreement was not
reached, a third researcher (S Choi) additionally analyzed the contents
till an agreement was reached. Judicial and clinical information were
collected. The judicial information includes type of defendant, the
process of lawsuit, the trial outcome, the plaintiff’s claim, the
claimed amount, and the payment awarded. For the claimed amount and
awarded compensation, 1 US Dollar (USD) was converted to 1,165 Korean
won based on the average exchange rate in 2019. Clinical information
such as the patient’s age and sex, indication of colonoscopy,
perforation cause and location, the type of surgical treatment, and
final outcomes were also collected. In addition, information pertaining
to the type of recognition of colon perforation, interventions for
perforation, and time elapsed from procedure to diagnosis of perforation
were also collected. The diagnosis time point for the colon perforation
was defined as the point at which perforation was confirmed with a
radiologic examination or a clinical suspicion by a doctor. We divided
the patients into three groups according to the degree of contamination
in the abdominal cavity, the occurrence of shock, and organ damage using
the classification of Flint14. Three groups were
defined as follows: grade 1 - cases of simple surgery, such as a suture,
grade 2 - cases in which the patient had temporary colostomy, and grade
3 - cases with cardiopulmonary resuscitation or deep shock events.Statistical analysisData normality was tested with the Shapiro-Wilk test. To compare the
three groups based on Flint’s classification, the Kruskal-Wallis tests
with Bonferroni’s correction for multiplicity were performed and
considered statistically significant when p < 0.05. All
statistical analyses were conducted using Microsoft Excel 2013 (Redmond,
WA, USA) and IBM SPSS Statistics 25 for windows (Chicago, IL, USA).Ethics statementThis retrospective study was approved by the Institutional Review Board
in Yonsei University Health System (No. Y-2020-0097) and informed
consent was waived.