Abstract
Background: Newer techniques such as mucosal resection, submucosal dissection and risky polypectomy will probably lead to increasing numbers of iatrogenic perforations. Reliable immediate closure of these lesions would increase safety and acceptance of the interventions. Methods: All acute directly observed perforations during diagnostic or therapeutic endoscopy were treated by the application of an over-the-scope clip. All consecutive patients from 2009 to August 2011 were followed in our tertiary referral center. The main outcome was technically successful closure of the perforation during endoscopy with a subsequent clinical observation for 24 h. Results: During the observation period, acute perforation occurred in 14 patients. All but 1 patient had technically successful treatment. Due to persistent abdominal pain, 3 patients had to be sent to the theater for laparoscopic evaluation after colon perforation. These 3 lesions were proven to be sealed and no resection of the colon was indicated. One patient with gastric adenocarcinoma had to be resected subtotally following endoscopic mucosal resection. Hospital stay ranged from 2 to 21 days. Conclusion: Directly observed perforations up to 30 mm diameter during endoscopy should be treated by deploying an over-the-scope clip. Endoscopists should be encouraged to be trained and to use over-the-scope clips in the stomach, duodenum and colon.
Journal Section:
Original Paper
References
1.
Geenen JE, Schmitt MG Jr, Wu WC, Hogan WJ: Major complications of coloscopy: bleeding and perforation. Am J Dig Dis 1975;20:231–235.
2.
Loffeld RJ, Engel A, Dekkers PE: Incidence and causes of colonoscopic perforations: a single-center case series. Endoscopy 2011;43:240–242.
3.
Repici A, Pellicano R, Strangio G, Danese S, Fagoonee S, Malesci A: Endoscopic mucosal resection for early colorectal neoplasia: pathologic basis, procedures, and outcomes. Dis Colon Rectum 2009;52:1502–1515.
[PubMed]
4.
Park YM, Cho E, Kang HY, Kim JM: The effectiveness and safety of endoscopic submucosal dissection compared with endoscopic mucosal resection for early gastric cancer: a systematic review and meta-analysis. Surg Endosc 2011;25:2666–2677.
5.
Farhat S, Chaussade S, Ponchon T, Coumaros D, Charachon A, Barrioz T, Koch S, Houcke P, Cellier C, Heresbach D, Lepilliez V, Napoleon B, Bauret P, Coron E, Le Rhun M, Bichard P, Vaillant E, Calazel A, Bensoussan E, Bellon S, Mangialavori L, Robin F, Prat F: Endoscopic submucosal dissection in a European setting. A multi-institutional report of a technique in development. Endoscopy 2011;43:664–670.
6.
Akasaka T, Nishida T, Tsutsui S, Michida T, Yamada T, Ogiyama H, Kitamura S, Ichiba M, Komori M, Nishiyama O, Nakanishi F, Zushi S, Nishihara A, Iijima H, Tsujii M, Hayashi N: Short-term outcomes of endoscopic submucosal dissection (ESD) for early gastric neoplasm: multicenter survey by Osaka University ESD Study Group. Dig Endosc 2011;23:73–77.
7.
Thill V, Simoens C, Mendes da Costa P: Management of iatrogenic perforation after gastrointestinal endoscopy. Hepatogastroenterology 2010;57:1465–1468.
8.
Jovanovic I, Zimmermann L, Fry LC, Monkemuller K: Feasibility of endoscopic closure of an iatrogenic colon perforation occurring during colonoscopy. Gastrointest Endosc 2011;73:550–555.
9.
Voermans RP, Vergouwe F, Breedveld P, Fockens P, van Berge Henegouwen MI: Comparison of endoscopic closure modalities for standardized colonic perforations in a porcine colon model. Endoscopy 2011;43:217–222.
10.
Magno P, Giday SA, Dray X, Chung SS, Cotton PB, Gostout CJ, Hawes RH, Kalloo AN, Pasricha PJ, White JJ, Assumpcao L, Marohn MR, Gabrielson KL, Kantsevoy SV: A new stapler-based full-thickness transgastric access closure: results from an animal pilot trial. Endoscopy 2007;39:876–880.
[PubMed]
11.
Schurr MO, Hartmann C, Ho CN, Fleisch C, Kirschniak A: An over-the-scope clip (OTSC) system for closure of iatrogenic colon perforations: results of an experimental survival study in pigs. Endoscopy 2008;40:584–588.
[PubMed]
12.
von Renteln D, Vassiliou MC, Rothstein RI: Randomized controlled trial comparing endoscopic clips and over-the-scope clips for closure of natural orifice transluminal endoscopic surgery gastrotomies. Endoscopy 2009;41:1056–1061.
13.
Kirschniak A, Kratt T, Stuker D, Braun A, Schurr MO, Konigsrainer A: A new endoscopic over-the-scope clip system for treatment of lesions and bleeding in the GI tract: first clinical experiences. Gastrointest Endosc 2007;66:162–167.
[PubMed]
14.
Seebach L, Bauerfeind P, Gubler C: ‘Sparing the surgeon’: clinical experience with over-the-scope clips for gastrointestinal perforation. Endoscopy 2010;42:1108–1111.
15.
Bretthauer M, Hoff GS, Thiis-Evensen E, Huppertz-Hauss G, Skovlund E: Air and carbon dioxide volumes insufflated during colonoscopy. Gastrointest Endosc 2003;58:203–206.
16.
Kirschniak A, Subotova N, Zieker D, Konigsrainer A, Kratt T: The over-the-scope clip (OTSC) for the treatment of gastrointestinal bleeding, perforations, and fistulas. Surg Endosc 2011;25:2901–2905.
17.
Sandmann M, Heike M, Faehndrich M: Application of the OTSC system for the closure of fistulas, anastomosal leakages and perforations within the gastrointestinal tract. Z Gastroenterol 2011;49:981–985.
18.
von Renteln D, Schmidt A, Vassiliou MC, Rudolph HU, Caca K: Endoscopic full-thickness resection and defect closure in the colon. Gastrointest Endosc 2010;71:1267–1273.
19.
von Renteln D, Rudolph HU, Schmidt A, Vassiliou MC, Caca K: Endoscopic closure of duodenal perforations by using an over-the-scope clip: a randomized, controlled porcine study. Gastrointest Endosc 2010;71:131–138.
20.
Carr-Locke DL: The changing management of colonoscopy-associated perforations. Digestion 2008;78:216–217.
[PubMed]
© 2012 S. Karger AG, Basel
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2012
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