Endoluminal suturing may overcome the limitations of clip closure of a gaping wide colon perforation (with videos) - 22/08/11
Reprint requests: G. S. Raju, MD, Center for Endoscopic Research, Education, and Training (CERTAIN), 4.106 McCullough Bldg, 301 University Blvd, University of Texas Medical Branch, Galveston, TX 77555-0764.Galveston, Texas, USA
Abstract |
Background |
It is unclear whether large gaping perforations of the colon can be closed by the endoluminal route.
Objective |
To evaluate the feasibility and the outcome of closure of large perforations of colon with clips and sutures by using through-the-endoscope novel devices.
Design |
Prospective animal study.
Setting |
University hospital.
Patients |
Ten pigs.
Interventions |
Closure of a 4-cm full-thickness colon perforation freshly created by an insulated-tip knife with the InScope Multi-Clip Applier (n = 6) and with the tissue approximation device (n = 4).
Main Outcome Measurements |
(a) Technical feasibility of closure, (b) clinical monitoring for 2 weeks, (c) necropsy (day 14), (d) healing by a dye-leak test and histology.
Results |
Endoluminal closure of a 4-cm–long colon perforation was successful in 9 of 10 animals. The clips failed to close a gaping wide colon perforation in 1 animal. The sutures were successful in the closure of both nongaping and gaping perforations. Successful closure resulted in a leakproof sealing at 2 weeks and prevented clinical peritonitis in all the animals in the clip-closure group and in 3 of 4 animals in the suture-closure group. Necropsy at 2 weeks revealed mild peritonitis in 2 of the 5 animals in the clip closure group and in 2 of the 4 animals in the suture-closure group; none developed fecal peritonitis.
Limitations |
None.
Conclusions |
Endoluminal closure of a 4-cm colon perforation with clips was successful in the majority of cases. Sutures were useful in the closure of gaping colon perforations that could not be closed with clips.
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| Presented at the Emerging Technology Forum, SAGES Meeting, Dallas, Texas, April 26-29, 2006. |
Vol 65 - N° 6
P. 906-911 - mai 2007 Retour au numéro
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