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

MedStar author(s):
Citation: Gastrointestinal Endoscopy. 84(3):487-93, 2016 SepPMID: 26364965Institution: MedStar Harbor HospitalForm of publication: Journal ArticleMedline article type(s): Comparative Study | Journal Article | Video-Audio MediaSubject headings: *Colonic Diseases/su [Surgery] | *Colonic Diseases/su [Surgery] | *Colonoscopy/mt [Methods] | *Colonoscopy/mt [Methods] | *Intestinal Perforation/su [Surgery] | *Intestinal Perforation/su [Surgery] | *Surgical Instruments | *Surgical Instruments | *Suture Techniques | *Suture Techniques | Adult | Adult | Aged | Aged | Aged, 80 and over | Aged, 80 and over | Colon/in [Injuries] | Colon/in [Injuries] | Colon/su [Surgery] | Colon/su [Surgery] | Colonic Diseases/et [Etiology] | Colonic Diseases/et [Etiology] | Colonoscopy/ae [Adverse Effects] | Colonoscopy/ae [Adverse Effects] | Female | Female | Humans | Humans | Intestinal Perforation/et [Etiology] | Intestinal Perforation/et [Etiology] | Male | Male | Middle Aged | Middle Aged | Retrospective Studies | Retrospective StudiesYear: 2016Local holdings: Available online from MWHC library: 1994 - present, Available in print through MWHC library: 1999 - 2006ISSN:
  • 0016-5107
Name of journal: Gastrointestinal endoscopyAbstract: BACKGROUND AND AIMS: Perforation during colonoscopy remains the most worrisome adverse event and usually requires urgent surgical rescue. The aim of this study was to evaluate the feasibility and effectiveness of endoscopic closure of full-thickness colonic perforations.CONCLUSION: 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. Copyright (c) 2016. Published by Elsevier Inc.METHODS: We performed a retrospective analysis of all consecutive patients with endoscopically closed colonic perforations over the past 6 years (2009-2014). Colonic perforations were closed by using endoscopic clips or an endoscopic suturing device. Most patients were admitted for treatment with intravenous antibiotics and kept on bowel rest. If their clinical condition deteriorated, urgent surgery was performed. If patients remained stable, oral feeding was resumed, and patients were discharged with subsequent clinical and endoscopic follow-up.RESULTS: Twenty-one patients had iatrogenic colonic perforations closed with an endoscopic suturing device or endoscopic clips during the study period. Primary closure of a colonic perforation was performed with endoscopic clips in 5 patients and sutured with an endoscopic suturing device in 16 patients. All 5 patients after clip closure had worsening of abdominal pain and required laparoscopy (4 patients) or rescue colonoscopy with endoscopic suturing closure (1 patient). Two patients had abdominal pain after endoscopic suturing closure, but diagnostic laparoscopy confirmed complete and adequate endoscopic closure of the perforations. The other 15 patients did not require any rescue surgery or laparoscopy after endoscopic suturing. The main limitation of our study is its retrospective, single-center design and relatively small number of patients.All authors: Alexander K, Bitner M, Cox ME, Fitzpatrick JL, Gushchin V, Hajiyeva G, Kantsevoy SV, Meenaghan N, Mirovski PM, Swope TFiscal year: FY2017Digital Object Identifier: Date added to catalog: 2017-09-15
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 26364965 Available 26364965

Available online from MWHC library: 1994 - present, Available in print through MWHC library: 1999 - 2006

BACKGROUND AND AIMS: Perforation during colonoscopy remains the most worrisome adverse event and usually requires urgent surgical rescue. The aim of this study was to evaluate the feasibility and effectiveness of endoscopic closure of full-thickness colonic perforations.

CONCLUSION: 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. Copyright (c) 2016. Published by Elsevier Inc.

METHODS: We performed a retrospective analysis of all consecutive patients with endoscopically closed colonic perforations over the past 6 years (2009-2014). Colonic perforations were closed by using endoscopic clips or an endoscopic suturing device. Most patients were admitted for treatment with intravenous antibiotics and kept on bowel rest. If their clinical condition deteriorated, urgent surgery was performed. If patients remained stable, oral feeding was resumed, and patients were discharged with subsequent clinical and endoscopic follow-up.

RESULTS: Twenty-one patients had iatrogenic colonic perforations closed with an endoscopic suturing device or endoscopic clips during the study period. Primary closure of a colonic perforation was performed with endoscopic clips in 5 patients and sutured with an endoscopic suturing device in 16 patients. All 5 patients after clip closure had worsening of abdominal pain and required laparoscopy (4 patients) or rescue colonoscopy with endoscopic suturing closure (1 patient). Two patients had abdominal pain after endoscopic suturing closure, but diagnostic laparoscopy confirmed complete and adequate endoscopic closure of the perforations. The other 15 patients did not require any rescue surgery or laparoscopy after endoscopic suturing. The main limitation of our study is its retrospective, single-center design and relatively small number of patients.

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