**Author details**

vic pain, abdominal pain, the peritoneal signs if perforation occurs, rectal bleeding, rectal mucous drainage, fecal incontinence, bowel obstruction, or drug overdose if bag ruptures

These symptoms and the management varies considerably based on the type of inserted ob‐ jects (sharp versus blunt), traumatic or not, and illicit drug involved or not [15,101]. Manage‐ ment of colorectal foreign bodies can be challenging and a systematic approach should be employed including abdominal plain film and CT scan to evaluate for free intra-abdominal air, shape and size of object, and its location and relations to the pelvis [15,100,101]. The ma‐ jority of cases can be successfully managed conservatively, but occasionally such as large ob‐ jects or tightly wedged in the pelvis surgical intervention is warranted [15,100]. It not recommended removing drug-containing bags endoscopically because of potential rupture of bags that can lead to systemic absorption of the drug which may cause death from rapid

These advanced techniques include endoscopic mucosal resection (EMR) and endoscopic sub‐ mucosal dissection (ESD) that have been used to remove benign and early malignant lesions that confined to superficial layers (mucosa and submucosa) [15,106]. Perforation and bleeding are the most common complications for EMR and ESD which are more frequent than with standard polypectomy [15]. The size of lesion, location, histology, the type of device used, and

Intraprocedural bleeding rate has been reported over 10% in several large studies with de‐ layed bleeding to up to 14% [15,101,102]. Bleeding usually is managed endoscopically, al‐

Perforation may occur in 0-5% and 5-10% in EMR and ESD respectively which is usually rec‐ ognized during the procedure and managed endoscopically, although delayed perforation

Despite these varieties of potential complications of colonoscopy and colonoscopic interven‐ tions, they occur in low rate. It is important for both patients and physicians to know these po‐ tential complications. Informing patients regarding the symptoms of these complications is of importance to seek medical attention in timely manner without delay. Also knowledge of these potential complications their frequency, risk factors, and appropriate interventions is essential

for endoscopists to minimize their incidence, detect and treat them without delay.

Special thanks to Dr. Eugene F Yen who took his time to review the chapter.

operator experience are the factors that affects complication rates [15,107-109].

during removal attempts in body pocking of illicit drugs [15,100,101,104].

230 Colonoscopy and Colorectal Cancer Screening - Future Directions

**3.8. Advanced techniques for colonoscopic tissue removal**

though it may require blood transfusion [15,110].

has been reported in 0.4% [15,107-111].

**4. Conclusion**

**Acknowledgements**

drug overdose [15,105].

Muhammed Sherid, Salih Samo and Samian Sulaiman

Saint Francis hospital, University of Illinois at Chicago, Evanston, Illinois, USA
