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Manongi N, Tsistrakis S. Endoscopic Management of Jejunal Perforation During Endoscopic Ultrasonography: A Case Report and Literature Review. Cureus 2023; 15:e43265. [PMID: 37577275 PMCID: PMC10413788 DOI: 10.7759/cureus.43265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2023] [Indexed: 08/15/2023] Open
Abstract
Endoscopic ultrasound is a useful diagnostic and interventional device for gastroenterologists. Although extremely useful, endoscopic ultrasound is not a benign tool. Possible complications of endoscopic ultrasound include hemorrhage, infection, and perforation. Although rare, iatrogenic small bowel perforations have been reported largely on the duodenum and rarely on the jejunum or ileum. Traditionally, these iatrogenic small bowel perforations have been managed with open surgery. However, recent emerging clinical data has revealed that immediate endoscopic treatment may be a feasible and safe alternative to surgery in select cases. Here, we describe the endoscopic management of an iatrogenic jejunal perforation during a linear endoscopic ultrasound examination managed successfully using an endoscopic clip.
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Affiliation(s)
- Ngoda Manongi
- Internal Medicine, NewYork-Presbyterian Queens, Flushing, USA
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2
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Sidiqi MM, Sharma S, Muhammed AH. Endoscopic management of gastric perforation secondary to chicken bone: A report of 2 cases. Int J Surg Case Rep 2019; 65:305-308. [PMID: 31760218 PMCID: PMC6883341 DOI: 10.1016/j.ijscr.2019.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 10/17/2019] [Accepted: 11/12/2019] [Indexed: 11/28/2022] Open
Abstract
The majority of ingested foreign bodies pass through the gastrointestinal tract harmlessly. Ingested foreign bodies can cause significant complications like bowel obstruction, bleeding, abscess formation, migration to other organs, and perforation. In selected cases, endoscopic management is more cost-effective, minimally invasive, has less post-operative complications, and leads to a more expeditious recovery.
Introduction Ingested foreign bodies (IFB) can uncommonly cause perforation of the gastrointestinal tract. The traditional management is surgical exploration via laparotomy or laparoscopy, although endoscopic options are now gaining prominence. Presentation of case We present two patients with almost identical clinical presentations of post-prandial abdominal pain and anorexia. On examination they were haemodynamically stable with localised epigastric tenderness. Both patients underwent CT scan of the abdomen, with one scan revealing a foreign body in the stomach penetrating the full thickness of the gastric wall with the tip lying extraluminally. They subsequently underwent endoscopy where a chicken bone was found perforating the wall of the stomach. This was removed via snare and endoscopic clips were used to close the site of perforation. Discussion The majority of ingested foreign bodies pass through the gastrointestinal tract harmlessly. However some IFBs can cause significant complications like bowel obstruction, bleeding, abscess formation, migration to other organs, and in our case perforation. The diagnosis may be delayed due to an insidious clinical presentation especially if the patient does not recall ingesting anything untoward. Our patients managed to avoid surgery by undergoing successful endoscopic therapy. Conclusion In selected cases, endoscopic management is more cost-effective, minimally invasive, has less post-operative complications, and leads to a more expeditious recovery. Therefore, the role of therapeutic endoscopy for gastric perforations secondary to foreign bodies should always be considered.
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Affiliation(s)
- M Masood Sidiqi
- General Surgery, Bunbury Regional Hospital, Western Australia, Australia.
| | - Siddhanth Sharma
- General Surgery, Bunbury Regional Hospital, Western Australia, Australia.
| | - Ausama H Muhammed
- General Surgery, Bunbury Regional Hospital, Western Australia, Australia.
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3
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Choi SH, Kim SJ, Kang DH, Kim HW, Choi CW, Kim TU, Lee JS, Ko JH. [Liver Abscess Secondary to Perforation after Duodenal Endoscopic Resection]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2018; 71:286-289. [PMID: 29791988 DOI: 10.4166/kjg.2018.71.5.286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Duodenal perforation is a complication of endoscopic mucosal resection. Liver abscess secondary to iatrogenic perforation is extremely rare. A 43-year-old female visited the hospital to remove a sub-epithelial tumor on the duodenal bulb. After endoscopic mucosal resection with band ligation, duodenal perforation occurred. Endoscopic closure was performed successfully using a clipping device to manage duodenal perforation. After 4 weeks, the patient visited our outpatient clinic due to abdominal pain and fever. Abdominal computed tomography showed liver abscess that involved segment three. Liver abscess was resolved with a 10-week antibiotic treatment. To the best of our knowledge, no case of liver abscess secondary to duodenal perforation by endoscopic resection was reported to date in Korea. Here, we report a case of liver abscess caused by a duodenal perforation after endoscopic mucosal resection.
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Affiliation(s)
- Seung Ho Choi
- Division of Gastroenterology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Su Jin Kim
- Division of Gastroenterology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Dae Hwan Kang
- Division of Gastroenterology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hyung Wook Kim
- Division of Gastroenterology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Cheol Woong Choi
- Division of Gastroenterology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Tae Un Kim
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Jeong Seok Lee
- Division of Gastroenterology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Ji Hwan Ko
- Division of Gastroenterology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
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Dedania B, Khanapara D, Panwala A, Dharan M. A Case of Mysterious Impacted Duodenal Foreign Body Presenting with Halitosis. Case Rep Gastroenterol 2017; 10:800-807. [PMID: 28203127 PMCID: PMC5260512 DOI: 10.1159/000454709] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 11/21/2016] [Indexed: 12/17/2022] Open
Abstract
The majority of gastrointestinal (GI) foreign bodies (FBs) discovered in adults are the result of intentional ingestion, most of which are found in patients with a preexisting psychiatric illness, with substance abuse disorders, or in people seeking secondary gain. No similar case of internal injuries following unintentional ingestion of a barbecue grill cleaning brush bristle has been reported. A 58-year-old Caucasian male with no significant history presented with complaint of halitosis, not improving after oral care and dental hygiene measures. He denied any other symptoms. After ruling out oral causes of halitosis, an esophagogastroduodenoscopy was performed, which revealed a black wire-shaped metallic FB embedded in the duodenum. The FB was identified as a silver metallic flexible wire resembling the bristle of a barbecue grill cleaning brush. The halitosis resolved completely within 3 weeks of the removal of the FB. To the best of our knowledge, this is the first case of duodenal impaction of a barbecue grill cleaning brush bristle atypically presenting with halitosis. Physicians’ awareness of this potential injury from grill cleaning brush bristles would lead to a quick diagnosis after a focused history. Also avid grillers must be made aware of this potential hazard and should be encouraged to carefully examine the barbecue grill surface for any remnant bristle of the grill cleaning brush. Appropriate history taking, considering GI causes as potentially inducing halitosis, and an awareness of this entity among providers are important to facilitate prompt diagnoses and prevent major adverse outcomes.
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Affiliation(s)
- Bhavtosh Dedania
- Department of Gastroenterology, Hepatology and Nutrition, University of Texas Health Science Center, Houston, TX, USA; Department of Medicine, University of Connecticut Health Center, Farmington, CT, USA
| | - Dipen Khanapara
- Department of Medicine, Montefiore Medical Center - North Division, Bronx, NY, USA
| | - Amruta Panwala
- Department of Medicine, University of Connecticut Health Center, Farmington, CT, USA
| | - Murali Dharan
- Department of Gastroenterology, Saint Francis Hospital, Hartford, CT, USA
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Kuwabara J, Watanabe Y, Kojima Y, Higaki N, Ikeda Y, Sato K, Yoshida M, Yamamoto Y, Kikuchi S. Successful closure of spontaneous esophageal rupture (Boerhaave's syndrome) by endoscopic ligation with snare loops. SPRINGERPLUS 2016; 5:921. [PMID: 27386365 PMCID: PMC4927538 DOI: 10.1186/s40064-016-2624-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 06/17/2016] [Indexed: 11/10/2022]
Abstract
Introduction Spontaneous esophageal rupture is a rare condition with a high mortality rate, and it is generally treated by surgery. In the present report, successful non-surgical closure of spontaneous esophageal rupture by endoscopic ligation with snare loops in a patient with pyopneumothorax and septicemia is presented. Case description The case of an 80-year-old man patient with spontaneous esophageal rupture who was cured by endoscopic ligation with snare loops is reported. The patient was admitted with severe chest pain. Chest CT scan revealed pneumomediastinum, and an upper gastrointestinal series using gastrografin showed leakage of contrast medium from the lower esophagus. Therefore, a diagnosis of spontaneous esophageal rupture to the thorax was made. Since the family refused surgery, the patient was treated conservatively. Since extensive blood in the stool was noted on day 5, an emergency endoscopic examination was performed. Clipping was performed around the perforation, and the clips were ligated with snare loops. The patient was discharged on day 83 without recurrence. Discussion and evaluation We suggest that endoscopic ligation with snare loops should be chosen for elderly people and high-risk cases.
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Affiliation(s)
- Jun Kuwabara
- Gastroenterology and Surgical Oncology, Ehime University School of Medicine, Shitsukawa, Toon City, Ehime 791-0295 Japan
| | - Yuji Watanabe
- Gastroenterology and Surgical Oncology, Ehime University School of Medicine, Shitsukawa, Toon City, Ehime 791-0295 Japan
| | - You Kojima
- Gastroenterology and Surgical Oncology, Ehime University School of Medicine, Shitsukawa, Toon City, Ehime 791-0295 Japan
| | - Naoyuki Higaki
- Departments of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon City, Japan
| | - Yoshiou Ikeda
- Departments of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon City, Japan
| | - Kouichi Sato
- Gastroenterology and Surgical Oncology, Ehime University School of Medicine, Shitsukawa, Toon City, Ehime 791-0295 Japan
| | - Motohira Yoshida
- Gastroenterology and Surgical Oncology, Ehime University School of Medicine, Shitsukawa, Toon City, Ehime 791-0295 Japan
| | - Yuji Yamamoto
- Gastroenterology and Surgical Oncology, Ehime University School of Medicine, Shitsukawa, Toon City, Ehime 791-0295 Japan
| | - Satoshi Kikuchi
- Gastroenterology and Surgical Oncology, Ehime University School of Medicine, Shitsukawa, Toon City, Ehime 791-0295 Japan
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6
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Dabizzi E, De Ceglie A, Kyanam Kabir Baig KR, Baron TH, Conio M, Wallace MB. Endoscopic "rescue" treatment for gastrointestinal perforations, anastomotic dehiscence and fistula. Clin Res Hepatol Gastroenterol 2016. [PMID: 26209869 DOI: 10.1016/j.clinre.2015.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Luminal perforations and anastomotic leaks of the gastrointestinal tract are life-threatening events with high morbidity and mortality. Early recognition and prompt therapy is essential for a favourable outcome. Surgery has long been considered the "gold standard" approach for these conditions; however it is associated with high re-intervention morbidity and mortality. The recent development of endoscopic techniques and devices to manage perforations, leaks and fistulae has made non-surgical treatment an attractive and reasonable alternative approach. Although endoscopic therapy is widely accepted, comparative data of the different techniques are still lacking. In this review we describe, benefits and limitations of the current options in the management of patients with perforations and leaks, in order to improve outcomes.
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Affiliation(s)
- Emanuele Dabizzi
- Gastroenterology and Digestive Endoscopy Division, Vita-Salute San Raffaele Univeristy, San Raffaele Scientific Institute, Milan, Italy.
| | - Antonella De Ceglie
- Gastroenterology and Digestive Endoscopy Unit, "G. Borea" Hospital, San Remo, Italy
| | | | - Todd H Baron
- Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Massimo Conio
- Gastroenterology and Digestive Endoscopy Unit, "G. Borea" Hospital, San Remo, Italy
| | - Michael B Wallace
- Division of Gastroenterology and Hepatology, Mayo Clinic Jacksonville, Florida, USA
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Evaluating long-term attachment of a novel endoclip in porcine stomachs: a prospective study of initial deployment success and clip retention rates at different regions of the stomachs. Surg Endosc 2015; 30:1100-6. [DOI: 10.1007/s00464-015-4305-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 05/26/2015] [Indexed: 12/11/2022]
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8
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Ritter LA, Wang AY, Sauer BG, Kleiner DE. Healing of complicated gastric leaks in bariatric patients using endoscopic clips. JSLS 2014; 17:481-3. [PMID: 24018092 PMCID: PMC3771774 DOI: 10.4293/108680813x13693422521999] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Endoscopists have used clipping devices to successfully close acute, iatrogenic perforations throughout the gastrointestinal tract. We applied this technology to our bariatric patients, who tend to present with a more delayed anastomotic leak, to determine whether these leaks and fistulae would also heal with endoclip application. CASE DESCRIPTION We describe a small series of 2 clinically stable bariatric patients who presented with postoperative anastomotic leaks who met criteria for non-operative therapy. The first underwent a laparoscopic Roux-en-Y gastric bypass and presented postoperatively with a leak at her gastrojejunal anastomosis. The location was not amenable to stent placement; therefore, 2 endoclips were placed. The leak was sealed by fluoroscopic examination 14 d later. The second had a reversal of a previous gastric bypass, creating a new gastrogastric anastomosis. A leak was found at this new connection postoperatively. After failure of a stent to seal the leak, 8 endoclips were used. This patient also had successful closure of her leak on fluoroscopy 14 d postprocedure. DISCUSSION Anastomotic leaks after bariatric surgery can incur severe morbidity, cost, and detriment to patients' quality of life. Unstable patients require operative intervention. Stable patients are candidates for more-conservative measures. Endoscopic stents have been successful in closing gastric leaks, though some are not anatomically amenable to stent placement, and stents also have the potential to migrate distally. We demonstrate 2 cases of successful closure of leaks in bariatric patients by using endoclips and suggest that this be considered an option in appropriate cases.
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Affiliation(s)
- Lane A Ritter
- Department of General Surgery, University of Virginia Health System, Charlottesville, VA, USA
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9
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Cho EA, Lee DH, Hong HJ, Park CH, Park SY, Kim HS, Choi SK, Rew JS. An unusual case of duodenal perforation caused by a lollipop stick: a case report. Clin Endosc 2014; 47:188-91. [PMID: 24765603 PMCID: PMC3994263 DOI: 10.5946/ce.2014.47.2.188] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Revised: 05/26/2013] [Accepted: 07/05/2013] [Indexed: 01/08/2023] Open
Abstract
Most ingested foreign bodies often pass through the gastrointestinal tract uneventfully; however, complications such as perforation do occur. Most cases of perforation are caused by thin, pointed objects such as needles, toothpicks, or fish and chicken bones. Herein, we report an unusual case of duodenal perforation caused by a lollipop stick with blunt ends. A 23-year-old woman was admitted to the emergency department complaining of epigastric and right upper quadrant pain for the last 2 days. Abdominal computed tomography scans confirmed the presence of a foreign body in the duodenum, with signs of duodenal perforation and inflammation. The patient was not aware of ingesting the foreign body. Endoscopy revealed the presence of a lollipop stick in the duodenum, which was removed with forceps. The duodenal perforation was successfully managed by using hemoclips and a detachable snare.
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Affiliation(s)
- Eun Ae Cho
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Du Hyeon Lee
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Hyoung Ju Hong
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Chang Hwan Park
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Seon Young Park
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Hyun Soo Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Sung Kyu Choi
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Jong Sun Rew
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
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Lee TH, Han JH, Park SH. Endoscopic treatments of endoscopic retrograde cholangiopancreatography-related duodenal perforations. Clin Endosc 2013; 46:522-8. [PMID: 24143315 PMCID: PMC3797938 DOI: 10.5946/ce.2013.46.5.522] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 06/25/2013] [Indexed: 12/13/2022] Open
Abstract
Iatrogenic duodenal perforation associated with endoscopic retrograde cholangiopancreatography (ERCP) is a very uncommon complication that is often lethal. Perforations during ERCP are caused by endoscopic sphincterotomy, placement of biliary or duodenal stents, guidewire-related causes, and endoscopy itself. In particular, perforation of the medial or lateral duodenal wall usually requires prompt diagnosis and surgical management. Perforation can follow various clinical courses, and management depends on the cause of the perforation. Cases resulting from sphincterotomy or guidewire-induced perforation can be managed by conservative treatment and biliary diversion. The current standard treatment for perforation of the duodenal free wall is early surgical repair. However, several reports of primary endoscopic closure techniques using endoclip, endoloop, or newly developed endoscopic devices have recently been described, even for use in direct perforation of the duodenal wall.
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Affiliation(s)
- Tae Hoon Lee
- Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
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Ji JS, Cho YS. Endoscopic band ligation: Beyond prevention and management of gastroesophageal varices. World J Gastroenterol 2013; 19:4271-4276. [PMID: 23885137 PMCID: PMC3718894 DOI: 10.3748/wjg.v19.i27.4271] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 03/19/2013] [Accepted: 04/29/2013] [Indexed: 02/06/2023] Open
Abstract
Endoscopic band ligation (EBL) is the preferred endoscopic technique for the endoscopic treatment of acute esophageal variceal bleeding. EBL has also been used to treat nonvariceal bleeding. Recently, Han et al demonstrated that EBL can be a feasible and safe alternate technique for the management of iatrogenic gastric perforation especially in cases in which closure with endoclips is difficult. EBL is technically simpler to perform than other methods and provides a good view of the lesions under direct pressure and suction from the transparent ligation cap. EBL can be used even if the diameter of the perforation is greater than 10 mm or if there is a severe tangential angle. In this commentary, we discuss the efficacy and safety of EBL for the closure of iatrogenic gastrointestinal perforation. We also discuss the advantages and disadvantages of EBL for the treatment of nonvariceal bleeding.
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Kwon W, Jang JY, Ryu JK, Kim YT, Yoon YB, Kang MJ, Kim SW. Proposal of an endoscopic retrograde cholangiopancreatography-related perforation management guideline based on perforation type. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2012; 83:218-26. [PMID: 23091794 PMCID: PMC3467388 DOI: 10.4174/jkss.2012.83.4.218] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Revised: 07/19/2012] [Accepted: 07/30/2012] [Indexed: 12/14/2022]
Abstract
Purpose Consensus for endoscopic retrograde cholangiopancreatography (ERCP) related perforation management is lacking. We aimed to identify candidate patients for conservative management by examining treatment results and to introduce a simple, algorithm-based management guideline. Methods A retrospective review of 53 patients with ERCP-related perforation between 2000 and 2010 was conducted. Data on perforation site (duodenum lateral wall or jejunum, type I; para-Vaterian, type II), management method, complication, mortality, hospital stay, and hospital cost were reviewed. Comparative analysis was done according to the injury types and management methods. Results The outcome was greater
in the conservative group than the operative group with shorter hospital stay (20.6 days vs. 29.8 days, P = 0.092), less cost (10.6 thousand United States Dollars [USD] vs. 19.9 thousand USD, P = 0.095), and lower morbidity rate (22.9% vs. 55.6%, P = 0.017). Eighty-one percent (17/21) of type I injuries were operatively managed and 96.9% (31/32) of type II injuries were conservatively managed. Between the types, type II showed better results over type I with shorter hospital stay (19.3 days vs. 30.6 days, P = 0.010), less cost (9.5 thousand USD vs. 20.1 thousand USD, P = 0.028), and lower complication rate (18.8% vs. 57.1%, P = 0.004). There was no difference in mortality. Conclusion Type II injuries were conservatively manageable and demonstrated better outcomes than type I injuries. The management algorithm suggests conservative management in type II injuries without severe peritonitis or unsolved problem requires immediate surgical correction, including operative management in type I injuries unless endoscopic intervention is possible. Conservative management offers socio-medical benefits. Conservative management is recommended in well-selected patients.
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Affiliation(s)
- Wooil Kwon
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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13
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Iatrogenic duodenal perforation treated with endoscopic placement of metallic clips: a case report. Case Rep Med 2012; 2012:609750. [PMID: 22431936 PMCID: PMC3297480 DOI: 10.1155/2012/609750] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Revised: 11/05/2011] [Accepted: 11/23/2011] [Indexed: 12/16/2022] Open
Abstract
Perforation is one of the major complications encountered during endoscopic procedures. The standard of care for these complications is either surgical intervention or nonoperative medical approach with antibiotics and bowel rest with or without parenteral alimentation. Metallic clips, initially developed to secure hemostasis in bleeding, have been successfully used to close perforations in the gastrointestinal tract (GI) including the duodenum. This avoids perioperative morbidities associated with surgical intervention while limiting the leakage of intestinal contents and peritoneal contamination that is possible with medical management. We present a case of a patient with a lateral duodenal perforation during an endoscopic retrograde cholangiopancreatography (ERCP) which was successfully treated with immediate placement of metallic endoclips.
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Abstract
PURPOSE OF REVIEW Understanding the role of endoscopic closure techniques helps in expanding the endoscopist's role in the management of gastrointestinal neoplasia and explore new frontiers of minimally invasive endoluminal surgery. RECENT FINDINGS This article covers recent advances in endoscopic closure of various gastrointestinal perforations, with a special focus on devices, experimental evidence and clinical outcomes of endoscopic closure of gastrointestinal perforations. SUMMARY Endoscopic closure techniques help the endoscopist to walk on thin ice and save himself and the patient in the case of mishap.
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15
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Kim SH, Moon JS, Youn YH, Lee KM, Lee SJ. Management of the complications of endoscopic submucosal dissection. World J Gastroenterol 2011; 17:3575-9. [PMID: 21987602 PMCID: PMC3180012 DOI: 10.3748/wjg.v17.i31.3575] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Revised: 08/12/2010] [Accepted: 08/19/2010] [Indexed: 02/06/2023] Open
Abstract
Endoscopic submucosal dissection (ESD) is currently widely accepted as a standard treatment option for early gastrointestinal neoplasms in Korea. However, ESD has technical difficulties and a longer procedure time than conventional endoscopic resection. So it may have a higher risk of complications than conventional endoscopic resection techniques. We, the ESD study group of Korean Society of Gastrointestinal Endoscopy, have experienced many complications, mostly treated by endoscopic or conservative management. Here, we introduce and share our experiences for management of post ESD complications and review published papers on the topic.
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Moran EA, Gostout CJ, McConico AL, Michalek J, Huebner M, Bingener J. Assessing the invasiveness of NOTES perforated viscus repair: a comparative study of NOTES and laparoscopy. Surg Endosc 2011; 26:103-9. [PMID: 21792716 DOI: 10.1007/s00464-011-1834-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Accepted: 06/22/2011] [Indexed: 02/06/2023]
Abstract
BACKGROUND Natural orifice transluminal endoscopic surgery (NOTES) repair of perforated peptic ulcers may decrease surgical invasiveness and improve patient outcomes. METHODS Full thickness gastrotomy was created laparoscopically in swine followed by soilage time. Repair proceeded with a laparoscopic (n = 14) or the NOTES (n = 14) approach. For NOTES repair, the omentum was endoscopically pulled into the gastric lumen and clipped. Intraoperative and postoperative parameters were recorded, including arterial blood gas (ABG) analysis and serum samples for white blood cell (WBC), TNF-α, IL-1, and IL-6 analysis. RESULTS Twenty-four of 28 animals thrived to study completion. NOTES repair could not be accomplished in one animal. At necropsy, all repairs were intact. Blood pressure was equivalent between groups. Pulse examined during the last 30 min of each procedure revealed a slightly higher mean pulse in the animals undergoing NOTES procedures (NOTES, 102 ± 28; laparoscopy, 83 ± 24). ABG obtained at the conclusion of the procedure revealed a pH of 7.47 in NOTES animals and 7.43 in the laparoscopy animals (p = 0.06), a change from baseline in both groups. The final pCO(2) was lower in the NOTES group (NOTES, 40.62; laparoscopy, 47.49, p = 0.03). WBC counts were comparable on postoperative day (POD) 1 (NOTES, 21.1; laparoscopy, 19.0; p = 0.49). Mean TNF-α serum levels were equivalent at all time points between groups; however, TNF-α varied significantly from baseline to POD 7 (p = 0.002). CONCLUSION NOTES omental repair appears comparable to that of laparoscopy. The lower arterial pCO(2) at the conclusion of the NOTES procedure may be advantageous in critically ill patients.
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Affiliation(s)
- E A Moran
- Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Nam HS, Kim GH, Kim DU, Choi MK, Yi YS, Hwang JM, Kim S. [A case of duodenal perforation caused by biliary plastic stent treated with approximation using endoclip and detachable snare]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2011; 57:129-33. [PMID: 21350325 DOI: 10.4166/kjg.2011.57.2.129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Endoscopic retrograde biliary drainage (ERBD) is useful for the palliative decompression of biliary obstruction. However, the complications of ERBD include cholangitis, hemorrhage, acute pancreatitis, obstruction of the stent, and duodenal perforation. Pressure necrosis on the duodenal mucosa by the stent may contribute to perforation. Although duodenal perforation following ERBD is very rare compared to other complications, it can result in a fatal outcome. Recent reports describe nonsurgical treatment for small gastrointestinal perforation with localized peritonitis and suggest that endoclipping may be appropriate in the management of a well selected group of patients with iatrogenic perforation. We describe a case of duodenal perforation secondary to ERBD that was successfully treated with approximating using endoclip and detachable snare.
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Affiliation(s)
- Hyung Seok Nam
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
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18
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Endoscopic-assisted closure of a chronic colocutaneous fistula. Gastrointest Endosc 2010; 72:662-4. [PMID: 20417508 DOI: 10.1016/j.gie.2009.12.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2009] [Accepted: 12/16/2009] [Indexed: 02/08/2023]
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Nakagawa Y, Nagai T, Soma W, Okawara H, Nakashima H, Tasaki T, Hisamatu A, Hashinaga M, Murakami K, Fujioka T. Endoscopic closure of a large ERCP-related lateral duodenal perforation by using endoloops and endoclips. Gastrointest Endosc 2010; 72:216-7. [PMID: 20304402 DOI: 10.1016/j.gie.2009.10.040] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Accepted: 10/20/2009] [Indexed: 02/08/2023]
Affiliation(s)
- Yoshifumi Nakagawa
- Department of Gastroenterology, Oita Kouseiren Tsurumi Hospital, Beppu, Japan
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Lee TH, Bang BW, Jeong JI, Kim HG, Jeong S, Park SM, Lee DH, Park SH, Kim SJ. Primary endoscopic approximation suture under cap-assisted endoscopy of an ERCP-induced duodenal perforation. World J Gastroenterol 2010; 16:2305-10. [PMID: 20458771 PMCID: PMC2868227 DOI: 10.3748/wjg.v16.i18.2305] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Duodenal perforation during endoscopic retrograde cholangiopancreatography (ERCP) is a rare complication, but it has a relatively high mortality risk. Early diagnosis and prompt management are key factors for the successful treatment of ERCP-related perforation. The management of perforation can initially be conservative in cases resulting from sphincterotomy or guide wire trauma. However, the current standard treatment for duodenal free wall perforation is surgical repair. Recently, several case reports of endoscopic closure techniques using endoclips, endoloops, or fully covered metal stents have been described. We describe four cases of iatrogenic duodenal bulb or lateral wall perforation caused by the scope tip that occurred during ERCP in tertiary referral centers. All the cases were simply managed by endoclips under transparent cap-assisted endoscopy. Based on the available evidence and our experience, endoscopic closure was a safe and feasible method even for duodenoscope-induced perforations. Our results suggest that endoscopists may be more willing to use this treatment.
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Kim ID, Kang DH, Choi CW, Kim HW, Jung WJ, Lee DH, Chung CW, Yoo JJ, Ryu JH. Prevention of covered enteral stent migration in patients with malignant gastric outlet obstruction: a pilot study of anchoring with endoscopic clips. Scand J Gastroenterol 2010; 45:100-5. [PMID: 20030581 DOI: 10.3109/00365520903410554] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Placement of a self-expandable metal stent is a palliative treatment of choice for patients with malignant gastric outlet obstruction (GOO). Although covering an enteral stent with a membrane almost solves the problem of tumor ingrowth, stent migration continues to be a major unresolved problem. Our aim was to evaluate the clinical efficacy of endoscopic clipping for prevention of covered stent migration in the treatment of malignant GOO. MATERIAL AND METHODS A total of 25 consecutive patients with malignant GOO were evaluated prospectively. After deployment of a double-layered combination stent (comprising an outer uncovered stent and an inner covered stent), three endoscopic clips were applied for fixation of the proximal end of the enteral stent to the gastric or duodenal mucosa. RESULTS Technical and clinical success rates were 100% (25/25) and 88% (22/25), respectively. No stent migration was observed in any of the patients. Five patients (20%) experienced complications such as tumor overgrowth and stent compression. CONCLUSION Endoscopic clipping for enteral stent placement seems to be effective for prevention of covered stent migration in patients with malignant GOO.
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Affiliation(s)
- Il Du Kim
- Department of Internal Medicine, Medical Research Institute, Pusan National University School of Medicine and Medical Research Institute, Yangsan, South Korea
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22
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Aplicaciones de los clips en la terapéutica endoscópica actual. GASTROENTEROLOGIA Y HEPATOLOGIA 2010; 33:171-8. [DOI: 10.1016/j.gastrohep.2009.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Revised: 04/13/2009] [Accepted: 04/17/2009] [Indexed: 12/17/2022]
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23
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Mangiavillano B, Viaggi P, Masci E. Endoscopic closure of acute iatrogenic perforations during diagnostic and therapeutic endoscopy in the gastrointestinal tract using metallic clips: a literature review. J Dig Dis 2010; 11:12-8. [PMID: 20132426 DOI: 10.1111/j.1751-2980.2009.00414.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Iatrogenic perforations that occur during the endoscopic procedures are generally surgically managed, even if some authors prefer a non-surgical approach in selected cases. The endoscopic application of metallic clips has been widely used in the gastrointestinal (GI) tract for hemostasis and also for marking lesions. Since 1993 several series of endoscopic perforations treated with endoclips have been described in the literature. In this review we offer a descriptive analysis of the reported cases of the acute iatrogenic perforation, describing the closure of different perforations occurring in the GI tract, treated with metallic clips.
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Affiliation(s)
- Benedetto Mangiavillano
- Department of Gastroenterology and Gastrointestinal Endoscopy, San Paolo University Hospital, Milan, Italy.
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Moran EA, Gostout CJ, McConico AL, Bingener J. Natural orifice translumenal endoscopic surgery used for perforated viscus repair is feasible using lower peritoneal pressures than laparoscopy in a porcine model. J Am Coll Surg 2010; 210:474-9. [PMID: 20347740 DOI: 10.1016/j.jamcollsurg.2009.11.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Revised: 11/20/2009] [Accepted: 11/24/2009] [Indexed: 01/08/2023]
Abstract
BACKGROUND Procedure-related complications contribute to 1-year mortality in patients with perforated ulcers. Natural orifice translumenal endoscopic surgery (NOTES) might offer a new repair approach. STUDY DESIGN Swine were randomized to laparoscopic or NOTES repair. Laparoscopic gastrotomy creation (1 cm) was followed by 4 hours soilage time. After peritoneal cavity irrigation (per group assignment), repair proceeded with a laparoscopic or NOTES approach. For NOTES repair, omentum was endoscopically grasped, pulled into the gastric lumen, and fixed with metallic clips. Feasibility; time to complete procedures; pneumoperitoneal pressures; and clinical parameters, including necropsy and peritoneal culture at 2 weeks, were recorded. RESULTS NOTES repair failed in 1 animal (technical); repair was completed laparoscopically, and data were analyzed as intention to treat. Specific NOTES repair time (minutes) was comparable with laparoscopy (36 versus 46; p = 0.2). Mean abdominal pressure (mmHg) required to complete NOTES repair was lower than in laparoscopy (4 versus 12; p < 0.001). Nineteen of 23 animals thrived until necropsy at 2 weeks. Three animals succumbed to airway compromise in recovery; 1 NOTES animal failed to thrive on postoperative day 7. No intra-abdominal cause for these deaths was found. At necropsy all repairs were intact, and peritoneal cultures revealed a small and equivalent amount of colony-forming units in each group. CONCLUSIONS Endoscopic ulcer repair appears technically feasible with similar clinical and infectious outcomes to laparoscopy. The lower required pneumoperitoneal pressures used in these NOTES techniques are recognizable different outcomes from laparoscopy and can be advantageous in critically ill patients.
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Affiliation(s)
- Erica A Moran
- Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA
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Morgan KA, Fontenot BB, Ruddy JM, Mickey S, Adams DB. Endoscopic Retrograde Cholangiopancreatography Gut Perforations: When to Wait! When to Operate! Am Surg 2009. [DOI: 10.1177/000313480907500605] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Most perforations of the gastrointestinal tract during endoscopic retrograde cholangiopancreatography (ERCP) can be managed nonoperatively. Identifying patients who require operative management is problematic. A clinical endoscopy database was queried for patients who sustained ERCP perforation over a 13-year period. Records were reviewed and analyzed with approval of the Institutional Review Board. During the study period, 12,817 patients underwent ERCP; 24 (0.2%) had an endoscopic perforation. Twelve patients had a retroperitoneal perforation during sphincterotomy and all were successfully managed nonoperatively. Nine of these were undergoing treatment for sphincter of Oddi dysfunction. Twelve patients had perforation remote from the papilla. Of these, 10 required surgical intervention. Six patients had surgically altered anatomy (three postpancreaticoduodenectomy, three post-Billroth II gastrectomy) and one had situs inversus. Six of these seven required surgical intervention. Median length of stay of all patients was 7.5 days, morbidity was 25 per cent, and one patient died 16 days after surgery. Gut perforation after ERCP requires prompt surgical evaluation. Patients with sphincterotomy-related retroperitoneal perforation can be managed safely with nonoperative therapy in most instances. Patients with remote perforation usually need surgical intervention. Altered foregut anatomy leads to injuries that usually require operative management.
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Affiliation(s)
- Katherine A. Morgan
- Section of Gastrointestinal and Laparoscopic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Bennett B. Fontenot
- Section of Gastrointestinal and Laparoscopic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Jean M. Ruddy
- Section of Gastrointestinal and Laparoscopic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Suzanne Mickey
- Section of Gastrointestinal and Laparoscopic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - David B. Adams
- Section of Gastrointestinal and Laparoscopic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
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Abstract
Surgery has been the mainstay of therapy in patients with gastrointestinal perforations. This paradigm started to shift with the development of techniques for endoscopic closure of gastrointestinal perforations. A detailed review of the literature on this subject, along with a commentary on practical aspects in the management of patients with gastrointestinal leaks, is provided here.
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Abstract
Endoscopic clips are relatively new devices that have been shown to be effective for the control of acute gastrointestinal hemorrhage. Various different models are available and offer simplicity of use with relatively few complications. Recently, endoscopic clips have been used for a variety of non-hemorrhagic conditions. In this article we review the literature and present current thinking about the indications, efficacy and safety of these devices.
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Affiliation(s)
- Michael J Grupka
- Department of Medicine, University of Connecticut Health Center, Farmington, Connecticut, USA.
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Abstract
The acute abdomen accounts for up to 40% of all emergency-surgical hospital admissions and is considered in the differential in the more than 7 million visits to the emergency department annually for abdominal pain in the United States. A large percentage of these cases are secondary to perforation or impending gastrointestinal perforation. Gastrointestinal perforation causes considerable mortality and usually requires emergency surgery.Rapid diagnosis and treatment of these conditions is essential to reduce the high morbidity and mortality of late-stage presentation. Successful treatment requires a thorough understanding of the anatomy, microbiology, and pathophysiology of this disease process and in-depth knowledge of the therapy, including resuscitation,antibiotics, source control, and physiologic support.
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Affiliation(s)
- John T Langell
- Department of Surgery, University of Utah, 30 North 1900 East, SOM 3B115, Salt Lake City, UT 84132, USA.
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29
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Shin EJ, Ko CW, Magno P, Giday SA, Clarke JO, Buscaglia JM, Sedrakyan G, Jagannath SB, Kalloo AN, Kantsevoy SV. Comparative study of endoscopic clips: duration of attachment at the site of clip application. Gastrointest Endosc 2007; 66:757-61. [PMID: 17905019 DOI: 10.1016/j.gie.2007.03.1049] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2006] [Accepted: 03/05/2007] [Indexed: 02/08/2023]
Abstract
BACKGROUND Several designs of endoscopic clips are now commercially available, and the indications for endoclip application are rapidly expanding. However, very limited data have been published to aid in choosing between the different types of endoclips. OBJECTIVE To compare the duration of clip attachment between all commercially available endoclips. SETTING Long-term experiments on 50-kg pigs under general anesthesia. DESIGN AND INTERVENTIONS Upper endoscope was inserted into the stomach. One clip of each type (Resolution clip, TriClip, and HX-5L clip) was placed along the same gastric fold at a distance of 0.5 to 1 cm from each other. The animals were recovered. In pig nos. 1 and 2, repeat endoscopy was performed after 2 and 4 weeks. In pig nos. 3 to 5, endoscopy was repeated after 1, 2, and 5 weeks. MAIN OUTCOME MEASUREMENTS Duration of clip retention at the site of application. RESULTS In all animals, only the Resolution endoclip remained attached to the site of application for the entire duration of the study (4-5 weeks). No TriClips or HX-5L clips were attached at the 4- to 5-week follow-up endoscopies. Most of the TriClips (67%) detached within the first week after application. Most of the HX-5L clips (80%) dislodged within the first 2 weeks of follow-up. LIMITATIONS The study was performed in a porcine model with a small number of animals. CONCLUSIONS The Resolution clip has the longest duration of retention at the site of application (more than 4-5 weeks) and should be preferred when long-term attachment of endoclips is necessary.
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Affiliation(s)
- Eun Ji Shin
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
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30
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Fischer A, Schrag HJ, Goos M, von Dobschuetz E, Hopt UT. Nonoperative treatment of four esophageal perforations with hemostatic clips. Dis Esophagus 2007; 20:444-8. [PMID: 17760660 DOI: 10.1111/j.1442-2050.2007.00652.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Spontaneous or iatrogenic esophageal perforations are despite advances of modern surgery and intensive care medicine still potentially life-threatening events with a considerable mortality rate. Recently, encouraging results on the sealing of esophageal perforations by placement of endoluminal prostheses were reported. However, if the perforation is very proximal (close to the larynx) or very distal (involving the cardia), the situation is to our experience unsuitable for stent therapy. In these special cases non-operative treatment is still possible by application of hemostatic metal clips. We present four cases unsuitable for stent therapy where the perforation was sealed by endoscopic clip application. All patients had an uneventful recovery. Non-operative treatment of esophageal perforations with hemostatic metal clips is feasible and safe in cases not treatable with self-expanding metal stents.
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Affiliation(s)
- A Fischer
- Department of General and Visceral Surgery, Albert-Ludwigs University of Freiburg, Germany.
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31
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Taku K, Sano Y, Fu KI, Saito Y, Matsuda T, Uraoka T, Yoshino T, Yamaguchi Y, Fujita M, Hattori S, Ishikawa T, Saito D, Fujii T, Kaneko E, Yoshida S. Iatrogenic perforation associated with therapeutic colonoscopy: a multicenter study in Japan. J Gastroenterol Hepatol 2007; 22:1409-14. [PMID: 17593224 DOI: 10.1111/j.1440-1746.2007.05022.x] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM Colonic perforation is the serious accidental complication. The aim of this study is to analyze the clinical presentation and management of recent iatrogenic perforations during therapeutic colonoscopy. METHODS Consecutive patients referred to four academic cancer centers in Japan were retrospectively reviewed using each center's endoscopy database of medical records. Data was obtained by means of an extensive data collection sheet. Since we evaluated the data including iatrogenic perforation during newly developed therapeutic procedure such as endoscopic submucosal dissection (ESD) or hemoclips, the collection of patient data was set from the period of the beginning of ESD technique in each hospital in this study. RESULTS The overall rate of occurrence of perforation was 0.15% (23/15, 160). Perforation rate for EMR (0.58%) showed a significantly higher rate (P < 0.0001) than that for hot biopsy and polypectomy. The rate for ESD (14%) showed a markedly higher rate (P < 0.0001) than that for other standard procedures. Of those perforations, endoscopic clipping was performed in 56.5% of the patients, and conservative treatment was successful in 100% of the patients with successful closure. Both CT scan findings and serology results (WBC, CRP) after perforation were poor predictors for need for surgery as opposed to conservative management. CONCLUSIONS Further improvements in EMR with special knife techniques are required to simply and safely remove large colorectal neoplasms, because perforation rate for ESD shows a markedly higher. Conservative management may be possible in patients who have undergone complete endoscopic clipping.
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Affiliation(s)
- Keisei Taku
- Division of Endoscopy and Gastrointestinal Oncology, National Cancer Center Hospital East, Chiba, Japan
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Fan CS, Soon MS. Repair of a polypectomy-induced duodenal perforation with a combination of hemoclip and band ligation. Gastrointest Endosc 2007; 66:203-5. [PMID: 17521637 DOI: 10.1016/j.gie.2006.11.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2006] [Accepted: 11/14/2006] [Indexed: 02/08/2023]
Affiliation(s)
- Chuan-San Fan
- Department of Gastroenterology, Changhua Christian Medical Center, Changhua, Taiwan
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Abstract
Endoscopic closure of gastrointestinal perforations, fistulas, and anastomotic dehiscence is technically feasible. Endoluminal closure of the instrumental perforations of the gastrointestinal tract can be accomplished immediately after the recognition of perforation, while avoiding the delay of arranging surgery and the trauma associated with thoracotomy or laparotomy. In addition, endoscopic closure should be considered in patients with anastomotic dehiscence and chronic fistulas as this may avoid the risk associated with reoperation. The outcome of closure depends on the technical expertise in the proper selection and use of various endoluminal closure options. Training of the endoscopists in the use of this novel technology will enhance the quality of care of our patients.
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Affiliation(s)
- G S Raju
- Center for Endoscopic Research, Training, and Innovation (CERTAIN), Department of Internal Medicine, 4.106 McCullough Building, 301 University Boulevard, University of Texas Medical Branch, Galveston, TX 77555-0764, USA.
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Katsarelias D, Polydorou A, Tsaroucha A, Pavlakis E, Dedemadi G, Pistiolis L, Karakostas N, Kondi-Paphiti A, Mallas E. Endoloop application as an alternative method for gastrotomy closure in experimental transgastric surgery. Surg Endosc 2007; 21:1862-5. [PMID: 17479337 DOI: 10.1007/s00464-007-9281-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2006] [Revised: 10/10/2006] [Accepted: 10/25/2006] [Indexed: 12/21/2022]
Abstract
BACKGROUND Experimental studies investigating transgastric endoscopic surgery report closure of the gastric wall incision with clips. The author of this report describes endoloop placement as an alternative, equally efficient, faster method for gastrotomy closure. METHODS Eight female pigs with a mean weight of 30 kg were used. Abdominal endoscopic exploration and transgastric operations including hepatic biopsies, bilateral tubal ligation, cholecystectomy, and closure of the gastrotomy were performed. The experiment was divided into two parts. The first part included five animals, which were killed immediately after the procedure. The second part included five animals, which were kept alive and killed 15 to 20 days later. RESULTS The first part of the experiment, performed for technical skills acquisition, involved transgastric abdominal exploration, liver biopsies, and bilateral tubal ligation, which were successful for all five animals. The gastric wall incision was closed by applying clips in four animals and endoloops in one animal. During the autopsy at the end of the experiment, the sites of intervention were examined macroscopically. In the second part of the experiment, gastrotomy closure with endoloop application was performed in two animals and with clip application in one animal. All three animals survived, gained weight, and demonstrated no signs of infection. They were killed 15 to 20 days after the procedure, and no signs of intraabdominal infection were found. Cultures from the peritoneal cavity were negative. At necropsy, macroscopic and microscopic examination confirmed complete healing of the gastrotomy. CONCLUSIONS Transgastric endoscopic surgery is technically feasible and effective. The application of endoloops for closure of the gastric opening is a fast, easy, and equally safe alternative to clip placement.
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Affiliation(s)
- D Katsarelias
- Department of Surgery, Aretaieion Hospital, V. Sofias 76 avenue, 115 27, Athens, Greece.
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Abstract
Endoscopy is commonly used in patients undergoing Roux-en-Y gastric bypass (RYGBP) for diagnosis and intervention. Stomal stricture at the gastrojejunostomy occurs in approximately 3% to 17% of patients after laparoscopic RYGBP. The incidence of iatrogenic perforation during stomal balloon dilatation is reported to be 3% to 12% among these patients. Surgery has typically been required for iatrogenic perforation. With the availability of the endoclip, endoscopists are able to manage iatrogenic perforation non-operatively. We report a patient who had jejunal perforation during balloon dilatation after RYBGP, who was successfully closed with endoclip applications and managed non-operatively.
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Affiliation(s)
- Shou-Jiang Tang
- Division of Digestive Diseases, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX 75390-8887, USA.
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36
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Chuttani R, Barkun A, Carpenter S, Chotiprasidhi P, Ginsberg GG, Hussain N, Liu J, Silverman W, Taitelbaum G, Petersen B. Endoscopic clip application devices. Gastrointest Endosc 2006; 63:746-50. [PMID: 16650531 DOI: 10.1016/j.gie.2006.02.042] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Seewald S, Soehendra N. Perforation: part and parcel of endoscopic resection? Gastrointest Endosc 2006; 63:602-5. [PMID: 16564859 DOI: 10.1016/j.gie.2005.08.034] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2005] [Accepted: 08/27/2005] [Indexed: 02/08/2023]
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Mutignani M, Iacopini F, Dokas S, Larghi A, Familiari P, Tringali A, Costamagna G. Successful endoscopic closure of a lateral duodenal perforation at ERCP with fibrin glue. Gastrointest Endosc 2006; 63:725-7. [PMID: 16564890 DOI: 10.1016/j.gie.2005.11.028] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2005] [Accepted: 11/15/2005] [Indexed: 12/12/2022]
Affiliation(s)
- Massimiliano Mutignani
- Digestive Endoscopy Unit, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168 Rome, Italy
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40
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Aksoz K, Yoruk G, Buyrac Z, Unsal B, Haciyanli M, Bocutoglu A, Kozacioglu Z. Transanal Endoscopic Repair of Rectal Perforation with Hemoclips. J Laparoendosc Adv Surg Tech A 2005; 15:170-2. [PMID: 15898911 DOI: 10.1089/lap.2005.15.170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A 74-year-old male patient had a full-thickness laceration of the mid-rectum during transurethral urologic surgery. The perforation site was 8-cm above the dentate line and 15 x 6 mm in size. Transanal direct access to the injury site was difficult and endoscopic repair with hemoclips was performed without any further intervention. He was discharged from the hospital uneventfully and complete healing was observed 6 weeks after the procedure. We concluded that endoscopic repair with hemoclips may offer a successful and simple closure method for extraperitoneal high lying rectal lacerations.
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Affiliation(s)
- Kadir Aksoz
- Ataturk Teaching and Research Hospital, Izmir, Turkey.
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41
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Matsuda T, Fujii T, Emura F, Kozu T, Saito Y, Ikematsu H, Saito D. Complete closure of a large defect after EMR of a lateral spreading colorectal tumor when using a two-channel colonoscope. Gastrointest Endosc 2004; 60:836-8. [PMID: 15557972 DOI: 10.1016/s0016-5107(04)02033-4] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Takahisa Matsuda
- Gastrointestinal Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
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Charabaty-Pishvaian A, Al-Kawas F. Endoscopic treatment of duodenal perforation using a clipping device: case report and review of the literature. South Med J 2004; 97:190-3. [PMID: 14982273 DOI: 10.1097/01.smj.0000091031.77846.b6] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The standard treatment for gastrointestinal perforation secondary to an endoscopic procedure is surgical repair. Some authors advocate a conservative medical management. However, this approach may be associated with increased morbidity and mortality. We describe a case of duodenal perforation secondary to snare polypectomy that was successfully treated with endoclipping. Additional published case reports were reviewed. Current data suggest that endoclipping may be appropriate in the management of a select group of patients with iatrogenic gastrointestinal perforation.
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Affiliation(s)
- Gottumukkala S Raju
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas 77555-0764, USA
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Familiari P, Macrì A, Consolo P, Angiò L, Scaffidi MG, Famulari C, Familiari L. Endoscopic clipping of a colocutaneous fistula following necrotizing pancreatitis: case report. Dig Liver Dis 2003; 35:907-10. [PMID: 14703889 DOI: 10.1016/j.dld.2003.05.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The case described here is of a 73-year-old male patient who developed a colocutaneous fistula following necrotizing pancreatitis, diagnosed by imaging and treated endoscopically by the application of an endoclip. Pancreatic and gastrointestinal fistulas, common complications of surgery for necrotizing pancreatitis, frequently require surgical treatment. Colonic perforations are the most difficult to treat surgically on account of the risk of peritonitis. A technique, namely, endoscopic clips application, has recently been developed to close anastomotic leakages and perforations of the oesophagus, stomach and colon. In the patient described here, endoscopic repair was technically easy and the good result was confirmed within a few days. In order to repair colonic fistulas following pancreatitis, application of endoclips could, in our opinion, provide a useful therapeutic option, feasible in selected patients.
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Affiliation(s)
- P Familiari
- Emergency Surgery Unit, University of Messina, Messina, Italy.
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Abstract
Iatrogenic perforation of the gastrointestinal tract is a medical emergency and is inevitable. An endoscopist must maintain a high index of suspicion despite minimal or atypical symptoms and negative radiologic studies, because perforation is a complication with tremendous morbidity and mortality. The endoscopist must know how to manage this complication appropriately and to seek immediate surgical consultation. There is ongoing controversy about when a patient should undergo nonoperative or surgical therapy. An evidence-based approach to manage iatrogenic perforation is not possible. The trend in the modern era is to less invasive, nonoperative therapy, given advancements in ICU care and antibiotics. Laparoscopy or laparoscopic-assisted (minilaparotomy) surgery is also being increasingly used with outcomes comparable with conventional laparotomy. Experience and advancements in accessories have enabled endoscopic repair of iatrogenic perforation in many situations [84]. The management algorithms provided synthesize the pertinent literature into reasonable guidelines to follow. Ultimately, an individualized approach must be taken to manage the patient with an iatrogenic perforation.
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Affiliation(s)
- Rajesh V Putcha
- Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center at Dallas, Room F.4.310, 5323 Harry Hines Boulevard, Dallas, TX 75390-8887, USA
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Fairbanks KD, Kalloo AN. Therapeutic endoscopic retrograde cholangiopancreatography: what the future holds. Gastrointest Endosc Clin N Am 2003; 13:799-809. [PMID: 14986799 DOI: 10.1016/s1052-5157(03)00073-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
These are exciting times for interventional endoscopists performing ERCP. The advent of noninvasive, diagnostic techniques of the pancreaticobiliary tree has resulted in a shift toward more therapeutic procedures. The combination of major technologic advances together with endoscopists' growing comfort with invasive procedures has helped to push the boundaries of endoscopic therapy. These therapies, however, should always be sanctioned by sound science and well-controlled clinical trials.
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Affiliation(s)
- Kyrsten D Fairbanks
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, MD 21205, USA
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Tsunada S, Ogata S, Ohyama T, Ootani H, Oda K, Kikkawa A, Ootani A, Sakata H, Iwakiri R, Fujimoto K. Endoscopic closure of perforations caused by EMR in the stomach by application of metallic clips. Gastrointest Endosc 2003; 57:948-51. [PMID: 12776053 DOI: 10.1016/s0016-5107(03)70051-0] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The number of complications associated with use of EMR for early-stage gastric cancer, including perforation, has increased with the increasing use of this procedure. Endoscopic clip application was performed in patients who sustained a perforation as a result of EMR for gastric neoplasm. PATIENTS AND METHODS Seven patients who underwent endoscopic application of metallic clips to close perforations were studied. The omental patch method was applied in one case with a large perforation. OBSERVATIONS In all patients, endoscopic clip application successfully closed the perforation of the stomach, which occurred after EMR. No patient required laparotomy. CONCLUSIONS The technique of endoscopic clip application might be useful for treatment of patients who sustain a perforation caused by EMR.
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Affiliation(s)
- Seiji Tsunada
- Department of Internal Medicine and Endoscopy, Saga Medical School, Saga, Japan
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Siu WT, Chau CH, Law BKB, Tang CN, Li MKW. Laparoscopic repair of iatrogenic endoscopic perforated peptic ulcer. J Laparoendosc Adv Surg Tech A 2003; 13:51-3. [PMID: 12676023 DOI: 10.1089/109264203321235485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Iatrogenic perforation is an uncommon but inevitable complication of endoscopy. Laparotomy has been the standard treatment for pyloroduodenal perforations caused by endoscopy. Laparoscopic repair is a well-documented treatment modality for spontaneously perforated peptic ulcer. We report our successful laparoscopic suture repair of perforations sustained during upper gastrointestinal endoscopy in two high-risk elderly patients.
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Affiliation(s)
- Wing Tai Siu
- Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong, SAR, China
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Saitoh Y, Watari J, Fujiya M, Kohgo Y. Endoscopic mucosal resection for flat and depressed type colorectal neoplasia. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2002. [DOI: 10.1053/tgie.2002.31946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Hashiba K, Carvalho AM, Diniz G, Barbosa de Aridrade N, Guedes CA, Siqueira Filho L, Lima CA, Coehlo HE, de Oliveira RA, Carvaiho AM, Coetho HE. Experimental endoscopic repair of gastric perforations with an omental patch and clips. Gastrointest Endosc 2001; 54:500-4. [PMID: 11577318 DOI: 10.1067/mge.2001.118444] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The omental patch is a standard surgical treatment of gastroduodenal ulcer perforation. This is a report of an experimental method for endoscopic repair of anterior gastric perforations with an omental patch developed by using a porcine model. METHODS A standardized gastric perforation was created in 10 pigs. The omentum was pulled into the gastric lumen and fixed endoscopically to the muscularis propria layer of the stomach with metallic clips. RESULTS The postoperative course was normal in 9 animals. An ulcer was evident at the site of repair at follow-up endoscopy. At autopsy, the omentum was adherent to the external side of gastric wall. One animal died with peritonitis, presumably because the muscularis propria layer could not be seen during the procedure, and the clips attached the omentum only to the mucosa. CONCLUSIONS Endoscopic repair with an omental patch appears to be an effective procedure for closure of gastric perforations.
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Affiliation(s)
- K Hashiba
- Faculdade de Medicina, Universidade Federal de Uberlândia Minas Gerais--Hospital Sírio Libanês, São Paulo, Brazil
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