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  • Title: Endoluminal suturing may overcome the limitations of clip closure of a gaping wide colon perforation (with videos).
    Author: Raju GS, Shibukawa G, Ahmed I, Brining D, Poussard A, Xiao SY, Coe J, Cropper M, Martin D, Hull J.
    Journal: Gastrointest Endosc; 2007 May; 65(6):906-11. PubMed ID: 17350009.
    Abstract:
    BACKGROUND: It is unclear whether large gaping perforations of the colon can be closed by the endoluminal route. OBJECTIVE: To evaluate the feasibility and the outcome of closure of large perforations of colon with clips and sutures by using through-the-endoscope novel devices. DESIGN: Prospective animal study. SETTING: University hospital. PATIENTS: Ten pigs. INTERVENTIONS: Closure of a 4-cm full-thickness colon perforation freshly created by an insulated-tip knife with the InScope Multi-Clip Applier (n = 6) and with the tissue approximation device (n = 4). MAIN OUTCOME MEASUREMENTS: (a) Technical feasibility of closure, (b) clinical monitoring for 2 weeks, (c) necropsy (day 14), (d) healing by a dye-leak test and histology. RESULTS: Endoluminal closure of a 4-cm-long colon perforation was successful in 9 of 10 animals. The clips failed to close a gaping wide colon perforation in 1 animal. The sutures were successful in the closure of both nongaping and gaping perforations. Successful closure resulted in a leakproof sealing at 2 weeks and prevented clinical peritonitis in all the animals in the clip-closure group and in 3 of 4 animals in the suture-closure group. Necropsy at 2 weeks revealed mild peritonitis in 2 of the 5 animals in the clip closure group and in 2 of the 4 animals in the suture-closure group; none developed fecal peritonitis. LIMITATIONS: None. CONCLUSIONS: Endoluminal closure of a 4-cm colon perforation with clips was successful in the majority of cases. Sutures were useful in the closure of gaping colon perforations that could not be closed with clips.
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