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

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. Methods We performed a retros...

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Bibliographic Details
Published in:Gastrointestinal endoscopy 2016-09, Vol.84 (3), p.487-493
Main Authors: Kantsevoy, Sergey V., MD, PhD, Bitner, Marianne, CRNA, Hajiyeva, Gulara, MD, Mirovski, Paulina M., BA, Cox, Michael E., MD, Swope, Thomas, MD, Alexander, Kelly, MD, Meenaghan, Nora, MD, Fitzpatrick, J. Lawrence, MD, Gushchin, Vadim, MD
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Colon - injuries
Colon - surgery
Colonic Diseases - etiology
Colonic Diseases - surgery
Colonoscopy - adverse effects
Colonoscopy - methods
Female
Gastroenterology and Hepatology
Humans
Intestinal Perforation - etiology
Intestinal Perforation - surgery
Male
Middle Aged
Retrospective Studies
Surgical Instruments
Suture Techniques
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Summary: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. 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. 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.
ISSN:0016-5107
1097-6779
DOI:10.1016/j.gie.2015.08.074