Original articleClinical endoscopyEndoscopic management of colonic perforations: clips versus suturing closure (with videos)
Graphical Abstract
Section snippets
Methods
We obtained permission from the institutional review board of Mercy Medical Center to perform a retrospective analysis of medical records of consecutive adult patients who had endoscopic closure of documented colonic perforations over the past 6 years (2009-2014).
All patients had undergone screening or therapeutic colonoscopy. Demographic and clinical data including patient age, sex, indications for colonoscopy, pathological diagnosis, lesion size and location, adverse events, and follow-up
Results
From 2009 to 2014, colonic perforations were closed endoscopically in 21 patients (Table 1). In 12 patients, colonoscopies were performed with the patient under deep sedation, whereas in 9, the patients were under general anesthesia.
Primary closure of colonic perforations was performed with endoscopic clips in 5 patients (Fig. 1) and with an Overstitch endoscopic suturing device in 16 patients (Fig. 2).
Patients in both groups (clip closure and endoscopic suturing closure) were similar in age
Discussion
Wider implementation of screening colonoscopy, improved polyp detection, and introduction of more aggressive endoscopic procedures for removal of colonic polyps (EMR and ESD) could cause an increased number of colonic perforations.1, 2, 3, 4, 5, 6, 7 Although previous animal experiments demonstrated the technical feasibility of colonic perforation closure with endoscopic clips and sutures, so far no dedicated clinical study has compared the reliability of various endoscopic techniques for
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DISCLOSURE: Dr Kantsevoy is a cofounder of and shareholder in Apollo Endosurgery Inc. All other authors disclosed no financial relationships relevant to this publication.
See CME section; p. 506.
If you would like to chat with an author of this article, you may contact Dr Kantesevoy at [email protected].