Endoscopic closure of iatrogenic colon perforation using dual-channel endoscope with an endoloop and clips: methods and feasibility data (with videos)

  • 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
  • Chang Hwan ChoiEmail author
New Technology



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.


Colonoscopy 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.

Supplementary material

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)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Internal MedicineChung-Ang University College of MedicineSeoulRepublic of Korea
  2. 2.Department of SurgeryChung-Ang University College of MedicineSeoulRepublic of Korea

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