Endoscopic repair of a large colonoscopic perforation with clips

Abstract

We report a patient with a large colonic perforation that occurred in a screening colonoscopy, successfully repaired with endoclips, although the safety and efficacy of this approach is not entirely established. Endoscopic clip placement can be used to treat iatrogenic colonic perforation, when the defect is readily recognized and is easily accessible for closure, and the bowel preparation is excellent.

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References

  1. 1.

    Silvis SE, Nebel O, Rogers G, Sugawa C, Mandelstam P (1976) Endoscopic Complications. Results of the 1974 American Society for Gastrointestinal Endoscopy Survey. JAMA 235:928–930

    PubMed  Article  CAS  Google Scholar 

  2. 2.

    Nelson DB, McQuaid KR, Bond JH, Lieberman DA, Weiss DG, Johnston TK (2002) Procedural success and complications of large-scale screening colonoscopy. Gastrointest Endosc 55:307–314

    PubMed  Article  Google Scholar 

  3. 3.

    Macrae FA, Tan KG, Williams CB (1983) Towards safer colonoscopy: a report on the complications of 5000 diagnostic or therapeutic colonoscopies. Gut 24:376–383

    PubMed  Article  CAS  Google Scholar 

  4. 4.

    Nivatvongs S (1986) Complications in colonoscopic polypectomy. An experience with 1555 polypectomies. Dis Colon Rectum 29:825–830

    PubMed  Article  CAS  Google Scholar 

  5. 5.

    Ghazi A, Grossman M (1982) Complications of colonoscopy and polypectomy. Surg Clin North Am 62:889–896

    PubMed  CAS  Google Scholar 

  6. 6.

    Thomson SR, Fraser M, Stupp C, Baker LW (1994) Iatrogenic and accidental colon injuries—what to do? Dis Colon Rectum 37:496–502

    PubMed  Article  CAS  Google Scholar 

  7. 7.

    Regan MC, Boyle B, Stephens RB (1994) Laparoscopic repair of colonic perforation occuring during colonoscopy. Br J Surg 81:1069–1073

    Article  Google Scholar 

  8. 8.

    Schlinkert RT, Rasmussen TE (1994) Laparoscopic repair of colonoscopic perforation of the colon. J Laparoendosc Surg 4:51–54

    PubMed  CAS  Google Scholar 

  9. 9.

    Hayashi K, Urata K, Munakata Y, Kawasaki S, Makuuchi M (1996) Laparoscopic closure for perforation of the sigmoid colon by endoscopic linear stapler. Surg Laparosc Endosc 6:411–413

    PubMed  Article  CAS  Google Scholar 

  10. 10.

    Miyahara M, Kitano S, Shimoda K, Bandoh T, Chikuba K, Maeo S et al (1996) Laparoscopic repair of a colonic perforation sustained during colonoscopy. Surg Endosc 10:352–353

    PubMed  Article  CAS  Google Scholar 

  11. 11.

    Wullstein C, Koppen MO, Gross E (1999) Laparoscopic treatment of colonic perforations related to colonoscopy. Surg Endosc 13:484–487

    PubMed  Article  CAS  Google Scholar 

  12. 12.

    Nassiopoulos K, Chanson C, Petropoulos P (1999) Perforation of the colon during colonoscopy. Swiss Surg 5:2–5

    PubMed  Article  CAS  Google Scholar 

  13. 13.

    Peterson N, Rohrmann CA Jr, Lennard ES (1982) Diagnosis and treatment of retroperitoneal perforation complicating the double-contrast barium-enema examination. Radiology 144:249–252

    PubMed  CAS  Google Scholar 

  14. 14.

    Hewetson KA, Dellipiani AW (1984) Massive subcutaneous emphysema following colonoscopy. Humphreys F, Hewetson KA, Dellipiani AW. Endoscopy 16:160–161

  15. 15.

    Christie JP, Marrazzo J (1991) “Mini-perforation” of the colon—not all postpolypectomy perforations require laparotomy. Dis Colon Rectum 34:132–135

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    Damore LJ, Rantis PC, Vernava AM, Longo WE (1996) Colonoscopic perforation. Etiology, diagnosis and management. Dis Colon Rectum 39:1308–1314

    PubMed  Article  Google Scholar 

  17. 17.

    Donckier V, André R (1993) Treatment of colon endoscopic perforations. Acta Chir Belg 93:60–62

    PubMed  CAS  Google Scholar 

  18. 18.

    Kavin H, Sinicrope F, Esker AH (1982) Management of perforation of the colon at colonoscopy. Am J Gastroenterol 87:161–167

    Google Scholar 

  19. 19.

    Farley DR, Bannon MP, Zietlow SP, Pemberton JH, Ilstrup DM, Larson DR (1997) Management of colonoscopic perforations. Mayo Clinic Proc 72:729–733

    CAS  Article  Google Scholar 

  20. 20.

    Raju GS, Gajula L (2004) Endoclips for GI endoscopy. Gastrointest Endosc 59:267–279

    PubMed  Article  Google Scholar 

  21. 21.

    Lo AY, Beaton HL (1994) Selective management of colonic perforations. J Am Coll Surg 179:333–337

    PubMed  CAS  Google Scholar 

  22. 22.

    Yoshikane H, Hidano H, Sakakibara A, Ayakawa T, Mori S, Kawashima H et al (1997) Endoscopic repair by clipping of iatrogenic colonic perforation. Gastrointest Endosc 46:464–466

    PubMed  Article  CAS  Google Scholar 

  23. 23.

    Mana F, De Vogelaere K, Urban D (2001) Iatrogenic perforation of the colon during diagnostic colonoscopy: endoscopic treatment with clips. Gastrointest Endosc 54:258–259

    PubMed  CAS  Google Scholar 

  24. 24.

    Raju GS, Pham B, Xiao SY, Brining D, Ahmed I (2005) A pilot study of endoscopic closure of colonic perforations with endoclips in a swine model. Gastrointest Endosc 62:791–795

    PubMed  Article  Google Scholar 

  25. 25.

    Khashab M, Rex D (2007) Persistence of resolution clips on colorectal polypectomy sites [Letter]. Gastrointest Endosc 66:635–636

    PubMed  Article  Google Scholar 

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Acknowledgement

The authors are grateful to Dr. Gottumukkala S. Raju, University of Texas Medical Branch, for his thoughtful revision on this report.

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Correspondence to Walton Albuquerque or Vitor Arantes.

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A large defect is observed in the sigmoid colon with minimal bleeding. A total of six endoscopic clips are placed sequentially to close entirely the defect. Observe that the bowel wall is deflated, as minimal insufflation of air was applied intentionally during the closure of the perforation. (WMV 6318 kb)

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Albuquerque, W., Moreira, E., Arantes, V. et al. Endoscopic repair of a large colonoscopic perforation with clips. Surg Endosc 22, 2072 (2008). https://doi.org/10.1007/s00464-008-9782-6

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Keywords

  • G-I
  • Endoscopy
  • Technical < Endoscopy
  • Bowel
  • Complications