Closing Perforations and Postperforation Management in Endoscopy

Stavropoulos, Stavros N.; Modayil, Rani J.; Friedel, David

doi:10.1016/j.giec.2014.09.008

Cited by 25 publications

(17 citation statements)

References 73 publications

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“…Through-the-scope (TTS) clips are useful for closing a small iatrogenic perforation, provided that the tissue surrounding the edges is compliant and nonfibrotic. TTS clips vary in terms of their diameter, rotation capacity, and deployment capability after multiple openings [30,31]. Generally, they may only be used to treat small defects (< 10 mm) because of their limited wingspan [32].…”

Section: Recommendationmentioning

confidence: 99%

See 1 more Smart Citation

Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement – Update 2020

et al. 2020

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Summary of Recommendations 1 ESGE recommends that each center implements a written policy regarding the management of iatrogenic perforations, including the definition of procedures that carry a higher risk of this complication. This policy should be shared with the radiologists and surgeons at each center. 2 ESGE recommends that in the case of an endoscopically identified perforation, the endoscopist reports its size and location, with an image, and statement of the endoscopic treatment that has been applied. 3 ESGE recommends that symptoms or signs suggestive of iatrogenic perforation after an endoscopic procedure should be rapidly and carefully evaluated and documented with a computed tomography (CT) scan. 4 ESGE recommends that endoscopic closure should be considered depending on the type of the iatrogenic perforation, its size, and the endoscopist expertise available at the center. Switch to carbon dioxide (CO2) endoscopic insufflation, diversion of digestive luminal content, and decompression of tension pneumoperitoneum or pneumothorax should also be performed. 5 ESGE recommends that after endoscopic closure of an iatrogenic perforation, further management should be based on the estimated success of the endoscopic closure and on the general clinical condition of the patient. In the case of no or failed endoscopic closure of an iatrogenic perforation, and in patients whose clinical condition is deteriorating, hospitalization and surgical consultation are recommended.

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Section: Recommendationmentioning

confidence: 99%

“…Generally, they may only be used to treat small defects (< 10 mm) because of their limited wingspan [32]. Larger perforations (> 10 mm but < 20 -25 mm) may be treated with over-the-scope (OTS) clips [30]. Defects larger than 30 mm are rather difficult to close endoscopically.…”

Section: Recommendationmentioning

confidence: 99%

Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement – Update 2020

et al. 2020

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“…The available clips have an open-jaw width rage from 9 to 16 mm, all have an outer sheath diameter of 7 Fr, and the sheath length rage from 230 to 235 cm. 35 Factors that should be considered before choosing TTS clip for closure are shape of the perforation, and compliance or viability of the perforation edge. In a prospective study of surviving porcine model on closure of esophageal perforation by TTS clip, endoscopic suture, and thoracoscopic repair, the mean length × width were 18 × 8, 15 × 6, and 18 × 7 mm, respectively.…”

Section: Endoscopic Managementmentioning

confidence: 99%

“…Most data were reported from EMR or ESD series and TTS clip showed technical and clinical success rate of 96.1% to 100% without reported mortality. 35 The perforation size developed from this procedure is usually small. In one report, the mean size of perforation caused by ESD was 2.5 mm with the maximum size of 5 mm.…”

mentioning

confidence: 99%

Endoscopic closure of iatrogenic perforation

Angsuwatcharakon

Rerknimitr

2016

Int J Gastrointest Interv

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A B S T R A C TIatrogenic perforation of the gastrointestinal (GI) tract is one of the serious complications in GI endoscopy. With the advancement in technique of GI endoscopy especially therapeutic endoscopy, the risk of perforation has increased. Prompt detection is the only way to avoid delay treatment and poor outcome. Recently, there are new instruments and techniques developed that can be reliably applied for an endoscopic closure without the need for surgery. Therefore, endoscopists should be familiar with these instruments as the result of successful endoscopic closure has lower rate of morbidity than surgery. In this review, the techniques of endoscopic closure are described according to the organs of perforation. In addition, the general knowledge and management of perforation in other aspects including tension pneumothorax, abdominal compartment syndrome, or infection induced by contamination of GI content are explained.

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“…In this pilot, ex vivo, porcine stomach model, modifications are made to the Apollo Overstitch system (Apollo Endosurgery, Austin, Tex), a currently approved and available device for which significant clinical experience in full-thickness closure has been well described, including defect closure and gastric plication. 5,6 In this method, an ESD technique is used to expose the submucosal and muscle layer in a perimeter surrounding the lesion of interest. A circumferential suturing pattern is then used in which a modified suture is placed that will allow for serosal-to-serosal apposition when the suture is tightened, essentially closing the future mural defect.…”

mentioning

confidence: 99%