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  • Title: Endoscopic closure of duodenal perforations by using an over-the-scope clip: a randomized, controlled porcine study.
    Author: von Renteln D, Rudolph HU, Schmidt A, Vassiliou MC, Caca K.
    Journal: Gastrointest Endosc; 2010 Jan; 71(1):131-8. PubMed ID: 19883907.
    Abstract:
    BACKGROUND: Duodenal perforations during diagnostic upper endoscopy are rare; however, when therapeutic techniques are performed, the reported incidence is as great as 2.8%. Surgical repair is usually mandated, but it is associated with significant morbidity and mortality. OBJECTIVE: To compare closure of duodenal perforations by using an over-the-scope clip (OTSC) with a surgical closure. DESIGN: Randomized, controlled animal study. SETTING: Animal facility laboratory. ANIMALS: Domestic pigs (24 females). INTERVENTIONS: Large (10-mm) duodenal perforations were created by using an endoscopic needle-knife. The animals were randomly assigned to either open surgical repair (n=12) or endoscopic closure by using the OTSC system (n=12). Pressurized leak tests were performed during necropsy. MAIN OUTCOME MEASUREMENTS: One major bleed occurred because of a liver injury during creation of the duodenotomy. Mean time for endoscopic closure was 5 minutes (range, 3-8 min; SD +/- 2). No complications occurred during any of the closure procedures. At necropsy, all OTSC and surgical closures demonstrated complete sealing of duodenotomy sites. Pressurized leak tests demonstrated a mean burst pressure of 166 mm Hg (range, 80-260; SD +/- 65) for OTSC closures and 143 mm Hg (range, 30-300, SD +/- 83) for surgical sutures. Ex vivo intact duodenal specimens exhibited a mean burst pressure of 247 mm Hg (range, 200-300; SD +/- 35), which was significantly higher compared with in vivo OTSC and surgical closures (P < .01). There were no significant differences between burst pressures of OTSC and surgical closures (P = .461). LIMITATIONS: Nonsurvival setting. CONCLUSIONS: Endoscopic closure of duodenal perforations by using the OTSC system is comparable with surgical closure in a nonsurvival porcine model. This technique is easy to perform and seems suitable for repairing duodenal perforations.
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