Endoscopic band ligation for closure of GI perforations in a porcine animal model (with video)

Law, Ryan; Deters, Jodie L.; Miller, Charles A.; Marler, Ronald J.; Baron, Todd H.

doi:10.1016/j.gie.2014.06.014

Cited by 6 publications

(6 citation statements)

References 16 publications

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“…Type I (lateral and medial wall) perforations caused by the endoscope tip require immediate surgery due to the clinical severity. However, with rapid developments in endoscopic treatment methods and devices in recent years, products and techniques such as fibrin glue [5], endoloops [6], endoclips [7,8], over-the-scope clipping devices [9], purse-string sutures [10], and open-pore film drainage [11] have been introduced for treating type I perforations [12]. The frequency of surgical or nonsurgical repair depends on the perforation type.…”

Section: Discussionmentioning

confidence: 99%

Repair of an Endoscopic Retrograde Cholangiopancreatography-Related Large Duodenal Perforation Using Double Endoscopic Band Ligation and Endoclipping

Kim

Choi

et al. 2017

Clin Endosc

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Endoscopic closure techniques have been introduced for the repair of duodenal wall perforations that occur during endoscopic retrograde cholangiopancreatography (ERCP). We report a case of successful repair of a large duodenal wall perforation by using double endoscopic band ligation (EBL) and an endoclip. Lateral duodenal wall perforation occurred during ERCP in a 93-year-old woman with acute calculous cholangitis. We switched to a forward endoscope that had a transparent band apparatus. A 2.0-cm oval-shaped perforation was found at the lateral duodenal wall. We repaired the perforation by sequentially performing double EBL and endoclipping. The first EBL was performed at the proximal edge of the perforation orifice, and two-thirds of the perforation were repaired. The second EBL, which also included the contents covered under the first EBL, repaired the defect almost completely. Finally, to account for the possible presence of a residual perforation, an endoclip was applied at the distal end of the perforation. The detection and closure of the perforation were completed within 10 minutes. We suggest that double EBL is an effective method for closure.

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Section: Discussionmentioning

confidence: 99%

Repair of an Endoscopic Retrograde Cholangiopancreatography-Related Large Duodenal Perforation Using Double Endoscopic Band Ligation and Endoclipping

Kim

Choi

et al. 2017

Clin Endosc

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“…EBL may prolong the hospital stay by binding together more tissue than required. In addition, it can cause injury to adjacent organs[25,26,54]. Further studies and developments are needed to expand EBL’s clinical use.…”

Section: New Devices and Techniquesmentioning

confidence: 99%

New devices and techniques for endoscopic closure of gastrointestinal perforations

Meng

et al. 2016

WJG

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Gastrointestinal perforations, which need to be managed quickly, are associated with high morbidity and mortality. Treatments used to close these perforations range from surgery to endoscopic therapy. Nowadays, with the development of new devices and techniques, endoscopic therapy is becoming more popular. However, there are different indications and clinical efficacies between different methods, because of the diverse properties of endoscopic devices and techniques. Successful management also depends on other factors, such as the precise location of the perforation, its size and the length of time between the occurrence and diagnosis. In this study, we performed a comprehensive review of various devices and introduced the different techniques that are considered effective to treat gastrointestinal perforations. In addition, we focused on the different methods used to achieve successful closure, based on the literature and our clinical experiences.

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“…It can be caused by trauma, severe peptic ulcer, neoplasm progression, and endoscopic procedures. − Unless treated, leakage of intragastric contents results in severe pain, heightened inflammatory response, and life-threatening sepsis. − The perforation causes bleeding where the gastric acid interferes with hemostasis, leading to poor perforation healing and a long hospital stay for patients. − Current treatment primarily relies on surgery and endoscopic closure; however, surgery often leads to serious trauma and has a high risk of intragastric contents leakage resulting from the longer (ca. 60 min) surgical time. , Although endoscopic closures of clips and occluders have also been widely used to repair gastric perforation, ,− the metal clips often fail to grasp the stiff inflammatory tissues surrounding the ulcer. , Furthermore, although occluders can effectively block chronic gastric perforation, the nondegradable metal and plastics require a second procedure to remove them (Table S1). Therefore, it is valuable to develop an endoscopy deliverable soft hydrogel with a drug-carrying capacity to effectively seal gastric perforation, prevent bleeding, and promote healing.…”

Section: Introductionmentioning

confidence: 99%

Endoscopy Deliverable and Mushroom-Cap-Inspired Hyperboloid-Shaped Drug-Laden Bioadhesive Hydrogel for Stomach Perforation Repair

et al. 2022

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Gastrointestinal tract perforation is a full-thickness injury that causes bleeding and fatal infection of the peritoneum. This condition worsens in an acidic gastric environment which interferes with the normal coagulation cascade. Current endoscopic clips to repair gastric perforations are ineffective, and metal or plastic occluders need secondary surgery to remove them. Herein, we report a self-expandable, endoscopy deliverable, adhesive hydrogel to block gastric perforation. We found the nanosilica coating significantly enhanced the adhesive strength even under a simulated strong acidic stomach environment. The developed device was disulfide cross-linked for the reducible degraded gel. By loading with vonoprazan fumarate (VF) and acidic fibroblast growth factor (AFGF), the hyperboloid-shaped device can have a sustained drug release to regulate intragastric pH and promote wound healing. The gel device can be compressed and then expanded like a mushroom when applied in an acute gastric perforation model in both rabbits and minipigs. By utilizing a stomach capsule robot for remotely monitoring the pH and by immunohistochemical analysis, we demonstrated that the compressible hyperboloid-shaped gel could stably block the perforation and promoted wound healing during the 28 days of observation. The real-time pH meter demonstrated that the gel could control intragastric pH above 4 for nearly 60 h to prevent bleeding.

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Endoscopic band ligation for closure of GI perforations in a porcine animal model (with video)

Cited by 6 publications

References 16 publications

Repair of an Endoscopic Retrograde Cholangiopancreatography-Related Large Duodenal Perforation Using Double Endoscopic Band Ligation and Endoclipping

Repair of an Endoscopic Retrograde Cholangiopancreatography-Related Large Duodenal Perforation Using Double Endoscopic Band Ligation and Endoclipping

New devices and techniques for endoscopic closure of gastrointestinal perforations

Endoscopy Deliverable and Mushroom-Cap-Inspired Hyperboloid-Shaped Drug-Laden Bioadhesive Hydrogel for Stomach Perforation Repair

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