Endoscopic management of colonic perforations: clips versus suturing closure (with videos)

Kantsevoy, Sergey V.; Bitner, Marianne; Hajiyeva, Gulara; Mirovski, Paulina M.; Cox, Michael; Swope, Thomas; Alexander, Kelly M.; Meenaghan, Nora; Fitzpatrick, J. Lawrence; Gushchin, Vadim

doi:10.1016/j.gie.2015.08.074

Cited by 96 publications

(51 citation statements)

References 25 publications

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“…In one small study, a novel purse-string suture technique was successfully used to close perforations developed during diagnostic colonoscopy, using a dual-channel endoscope with an endoloop and clips, without complications or subsequent surgery [246]. Endoscopic closure of perforations using suturing devices may also be effective, with promising results in a small retrospective study, but requires endoscope exchange and reinsertion, thereby risking extraluminal contamination [247].…”

Section: Treatment: Colorectummentioning

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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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: Treatment: Colorectummentioning

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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“…[9] Endoscopic suture closure of colonic perforations been shown to be feasible, and can even be more effective than clipping, but experience with this technique is limited. [11] The endoscopic clipping is a safe technique that eliminates the risk of general anesthesia and emergency surgery in patients with iatrogenic colon perforation. Although multiple clips were utilized for closure of perforation in our case, the overall cost of treatment was still low and affordable to the patient.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Management of an Iatrogenic Colonic Perforation Using Standard Hemoclips

Kumar

et al. 2018

Journal of Digestive Endoscopy

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Iatrogenic colonic perforation is an unusual but life‑threatening complication of colonoscopy. The recent advancement in endoscopy technology has made nonoperative treatment a safe and effective option for managing such perforations. A 70‑year‑old man sustained an iatrogenic sigmoid perforation during diagnostic colonoscopy. The abdominal X‑ray showed free gas under diaphragm. He was started on conservative management and intravenous antibiotics. He underwent a second colonoscopy after 2.5‑h, perforation was identified and closed with standard hemoclips. He recovered well and was discharged from hospital 6 days later. There are only a handful of reports in the medical literature describing successful outcomes following endoscopic management. Most of the cases have been managed with over‑the‑scope clips or endoscopic sutures that are quite expensive. In the present report, an iatrogenic sigmoid perforation was managed endoscopically with standard hemoclips. The hemoclip can be an effective, yet economical method of perforation repair in selected cases.

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“…Iatrogenic rectal perforation is uncommon, and it is a challenge to manage because of risk of infection . Herein, we present a case of endoscopic purse‐string suture (EPSS) closing a large rectal perforation successfully.…”

Section: Brief Explanationmentioning

confidence: 99%

Endoscopic purse‐string suture technique: An effective remedy for a large iatrogenic rectal perforation

Chen

Wan

2018

Digestive Endoscopy

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Endoscopic management of colonic perforations: clips versus suturing closure (with videos)

Abstract: Endoscopic suturing closure of colonic perforations is technically feasible, eliminates the need for rescue surgery, and appears more effective than closure with hemostatic endoscopic clips.

Cited by 96 publications

References 25 publications

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

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

Endoscopic Management of an Iatrogenic Colonic Perforation Using Standard Hemoclips

Endoscopic purse‐string suture technique: An effective remedy for a large iatrogenic rectal perforation

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