Endoscopic closure of iatrogenic colon perforation using dual-channel endoscope with an endoloop and clips: methods and feasibility data (with videos)
Colon perforation is the most serious complication associated with colonoscopic procedures. We performed a novel purse-string suture technique to close the iatrogenic colonic perforation using dual-channel endoscope with an endoloop and clips.
Iatrogenic colon perforations developed during diagnostic colonoscopy referred to a tertiary hospital over 10 years were considered for this endoscopic closure. An endoloop was inserted through the left channel of the endoscope and placed around the defect. The first clip was placed at the proximal site of the defect through the other channel of the endoscope, and the endoloop was anchored on the mucosa around the defect. Then, subsequent clips were placed next to previous clips and the endoloop was fixed. After the defect was encircled by the endoloop and clips, the rim of the opening was approximated by fastening the endoloop with a purse-string technique.
A total of 8 patients were admitted to our hospital because of iatrogenic colon perforations during diagnostic colonoscopy. Of these, 2 underwent laparoscopic surgery and 6 underwent endoscopic closure by this novel purse-string suture technique. The estimated diameters of the perforations were 20 mm. All cases were successfully treated in the endoscopy unit without sedation or general anesthesia, and recovered without any complication or subsequent operation. Abdominal pain had nearly resolved within 3 days after the procedure in all patients, and only mild peritonitis was observed.
Iatrogenic colon perforation can be treated with a purse-string suture technique using dual-channel endoscope with an endoloop and clips. This technique can be useful for relatively large colon perforations associated with diagnostic colonoscopy.
KeywordsColonoscopy Perforation Endoloop Clip
This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MEST) (No. 2017R1D1A1B03031924).
Compliance with ethical standards
Ja Young Ryu, Byung Kwan Park, Won-Seok Kim, Kisung Kim, Jae Young Lee, Young Kim, Jae Yong Park, Beom Jin Kim, Jeong Wook Kim, and Chang Hwan Choi have no conflicts of interest or financial ties to disclose.
Endoscopic closure of iatrogenic colon perforation using dual-channel endoscope with an endoloop and clips in case #1. Supplementary material 1 (MP4 42695 KB)
Endoscopic closure of iatrogenic colon perforation using dual-channel endoscope with an endoloop and clips in case #2. Supplementary material 2 (MP4 29114 KB)
- 1.Kim JS, Kim BW, Kim JI, Kim JH, Kim SW, Ji JS, Lee BI, Choi H (2013) Endoscopic clip closure versus surgery for the treatment of iatrogenic colon perforations developed during diagnostic colonoscopy: a review of 115,285 patients. Surg Endosc 27:501–504. https://doi.org/10.1007/s00464-012-2465-3 CrossRefGoogle Scholar
- 6.Park CH, Jung YS, Nam E, Eun CS, Park DI, Han DS (2016) Comparison of efficacy of prophylactic endoscopic therapies for postpolypectomy bleeding in the colorectum: a systematic review and network meta-analysis. Am J Gastroenterol 111:1230–1243. https://doi.org/10.1038/ajg.2016.287 CrossRefGoogle Scholar
- 8.Mangiavillano B, Viaggi P, Masci E (2010) Endoscopic closure of acute iatrogenic perforations during diagnostic and therapeutic endoscopy in the gastrointestinal tract using metallic clips: a literature review. J Dig Dis 11:12–18. https://doi.org/10.1111/j.1751-2980.2009.00414.x CrossRefGoogle Scholar
- 14.Paspatis GA, Dumonceau JM, Barthet M, Meisner S, Repici A, Saunders BP, Vezakis A, Gonzalez JM, Turino SY, Tsiamoulos ZP, Fockens P, Hassan C (2014) Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 46:693–711. https://doi.org/10.1055/s-0034-1377531 CrossRefGoogle Scholar
- 15.Lo AY, Beaton HL (1994) Selective management of colonoscopic perforations. J Am Coll Surg 179:333–337Google Scholar
- 16.Ker TS, Wasserberg N, Beart RW Jr (2004) Colonoscopic perforation and bleeding of the colon can be treated safely without surgery. Am Surg 70:922–924Google Scholar
- 21.Raithel M, Albrecht H, Scheppach W, Farnbacher M, Haupt W, Hagel AF, Schellerer V, Vitali F, Neurath MF, Schneider HT (2017) Outcome, comorbidity, hospitalization and 30-day mortality after closure of acute perforations and postoperative anastomotic leaks by the over-the-scope clip (OTSC) in an unselected cohort of patients. Surg Endosc 31:2411–2425. https://doi.org/10.1007/s00464-016-5242-x CrossRefGoogle Scholar
- 23.Katsinelos P, Kountouras J, Chatzimavroudis G, Zavos C, Pilpilidis I, Tzilves D, Paroutoglou G (2009) Endoscopic closure of a large iatrogenic rectal perforation using endoloop/clips technique. Acta Gastroenterol Belg 72:357–359Google Scholar
- 24.Dolezel R, Ryska O, Kollar M, Juhasova J, Kalvach J, Ryska M, Martinek J (2016) A comparison of two endoscopic closures: over-the-scope clip (OTSC) versus KING closure (endoloop + clips) in a randomized long-term experimental study. Surg Endosc 30:4910–4916. https://doi.org/10.1007/s00464-016-4831-z CrossRefGoogle Scholar
- 25.Martinek J, Ryska O, Tuckova I, Filipkova T, Dolezel R, Juhas S, Motlik J, Zavoral M, Ryska M (2013) Comparing over-the-scope clip versus endoloop and clips (KING closure) for access site closure: a randomized experimental study. Surg Endosc 27:1203–1210. https://doi.org/10.1007/s00464-012-2576-x CrossRefGoogle Scholar