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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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| Published in: | Gastrointestinal endoscopy 2016-09, Vol.84 (3), p.487-493 |
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| creator | 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 |
| description | 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. |
| doi_str_mv | 10.1016/j.gie.2015.08.074 |
| format | article |
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Lawrence, MD ; Gushchin, Vadim, MD</creator><creatorcontrib>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</creatorcontrib><description>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.</description><identifier>ISSN: 0016-5107</identifier><identifier>EISSN: 1097-6779</identifier><identifier>DOI: 10.1016/j.gie.2015.08.074</identifier><identifier>PMID: 26364965</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>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</subject><ispartof>Gastrointestinal endoscopy, 2016-09, Vol.84 (3), p.487-493</ispartof><rights>American Society for Gastrointestinal Endoscopy</rights><rights>2016</rights><rights>Copyright © 2016. Published by Elsevier Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c451t-e46018fa4377aae7681e4b83a7c1c3e483b3a088e88239a7177a8bf26c7d858e3</citedby><cites>FETCH-LOGICAL-c451t-e46018fa4377aae7681e4b83a7c1c3e483b3a088e88239a7177a8bf26c7d858e3</cites><orcidid>0000-0003-1329-7125 ; 0000-0002-8294-6507</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,786,790,27957,27958</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26364965$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kantsevoy, Sergey V., MD, PhD</creatorcontrib><creatorcontrib>Bitner, Marianne, CRNA</creatorcontrib><creatorcontrib>Hajiyeva, Gulara, MD</creatorcontrib><creatorcontrib>Mirovski, Paulina M., BA</creatorcontrib><creatorcontrib>Cox, Michael E., MD</creatorcontrib><creatorcontrib>Swope, Thomas, MD</creatorcontrib><creatorcontrib>Alexander, Kelly, MD</creatorcontrib><creatorcontrib>Meenaghan, Nora, MD</creatorcontrib><creatorcontrib>Fitzpatrick, J. Lawrence, MD</creatorcontrib><creatorcontrib>Gushchin, Vadim, MD</creatorcontrib><title>Endoscopic management of colonic perforations: clips versus suturing closure (with videos)</title><title>Gastrointestinal endoscopy</title><addtitle>Gastrointest Endosc</addtitle><description>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.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Colon - injuries</subject><subject>Colon - surgery</subject><subject>Colonic Diseases - etiology</subject><subject>Colonic Diseases - surgery</subject><subject>Colonoscopy - adverse effects</subject><subject>Colonoscopy - methods</subject><subject>Female</subject><subject>Gastroenterology and Hepatology</subject><subject>Humans</subject><subject>Intestinal Perforation - etiology</subject><subject>Intestinal Perforation - surgery</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Retrospective Studies</subject><subject>Surgical Instruments</subject><subject>Suture Techniques</subject><issn>0016-5107</issn><issn>1097-6779</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><recordid>eNp9kcFu1DAQhi0EotvCA3BBOZZDgid2bAekSqhqAakSB-DCxfI6k8VLEgdPsqhvj1dbOHDgZGn0_b_G3zD2AngFHNTrfbULWNUcmoqbimv5iG2At7pUWreP2YZnqGyA6zN2TrTnnJtawFN2ViuhZKuaDft2M3WRfJyDL0Y3uR2OOC1F7Asfhzjl6Yypj8ktIU70pvBDmKk4YKKVClqXNYVpl6eR1oTF5a-wfC8OocNIr56xJ70bCJ8_vBfs6-3Nl-sP5d2n9x-v392VXjawlCgVB9M7KbR2DrUygHJrhNMevEBpxFY4bgyavHzrNGTMbPtaed2ZxqC4YJen3jnFnyvSYsdAHofBTRhXsmCglqKVSmQUTqhPkShhb-cURpfuLXB7VGr3Niu1R6WWG5uV5szLh_p1O2L3N_HHYQbengDMnzwETJZ8wMljFxL6xXYx_Lf-6p90Vpy9u-EH3iPt45qmbM-Cpdpy-_l40-NJoeG1kVqI361nnCg</recordid><startdate>20160901</startdate><enddate>20160901</enddate><creator>Kantsevoy, Sergey V., MD, PhD</creator><creator>Bitner, Marianne, CRNA</creator><creator>Hajiyeva, Gulara, MD</creator><creator>Mirovski, Paulina M., BA</creator><creator>Cox, Michael E., MD</creator><creator>Swope, Thomas, MD</creator><creator>Alexander, Kelly, MD</creator><creator>Meenaghan, Nora, MD</creator><creator>Fitzpatrick, J. Lawrence, MD</creator><creator>Gushchin, Vadim, MD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-1329-7125</orcidid><orcidid>https://orcid.org/0000-0002-8294-6507</orcidid></search><sort><creationdate>20160901</creationdate><title>Endoscopic management of colonic perforations: clips versus suturing closure (with videos)</title><author>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</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c451t-e46018fa4377aae7681e4b83a7c1c3e483b3a088e88239a7177a8bf26c7d858e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Colon - injuries</topic><topic>Colon - surgery</topic><topic>Colonic Diseases - etiology</topic><topic>Colonic Diseases - surgery</topic><topic>Colonoscopy - adverse effects</topic><topic>Colonoscopy - methods</topic><topic>Female</topic><topic>Gastroenterology and Hepatology</topic><topic>Humans</topic><topic>Intestinal Perforation - etiology</topic><topic>Intestinal Perforation - surgery</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Retrospective Studies</topic><topic>Surgical Instruments</topic><topic>Suture Techniques</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kantsevoy, Sergey V., MD, PhD</creatorcontrib><creatorcontrib>Bitner, Marianne, CRNA</creatorcontrib><creatorcontrib>Hajiyeva, Gulara, MD</creatorcontrib><creatorcontrib>Mirovski, Paulina M., BA</creatorcontrib><creatorcontrib>Cox, Michael E., MD</creatorcontrib><creatorcontrib>Swope, Thomas, MD</creatorcontrib><creatorcontrib>Alexander, Kelly, MD</creatorcontrib><creatorcontrib>Meenaghan, Nora, MD</creatorcontrib><creatorcontrib>Fitzpatrick, J. Lawrence, MD</creatorcontrib><creatorcontrib>Gushchin, Vadim, MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Gastrointestinal endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kantsevoy, Sergey V., MD, PhD</au><au>Bitner, Marianne, CRNA</au><au>Hajiyeva, Gulara, MD</au><au>Mirovski, Paulina M., BA</au><au>Cox, Michael E., MD</au><au>Swope, Thomas, MD</au><au>Alexander, Kelly, MD</au><au>Meenaghan, Nora, MD</au><au>Fitzpatrick, J. Lawrence, MD</au><au>Gushchin, Vadim, MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Endoscopic management of colonic perforations: clips versus suturing closure (with videos)</atitle><jtitle>Gastrointestinal endoscopy</jtitle><addtitle>Gastrointest Endosc</addtitle><date>2016-09-01</date><risdate>2016</risdate><volume>84</volume><issue>3</issue><spage>487</spage><epage>493</epage><pages>487-493</pages><issn>0016-5107</issn><eissn>1097-6779</eissn><notes>ObjectType-Article-2</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Undefined-1</notes><notes>ObjectType-Feature-3</notes><notes>content type line 23</notes><abstract>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.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>26364965</pmid><doi>10.1016/j.gie.2015.08.074</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0003-1329-7125</orcidid><orcidid>https://orcid.org/0000-0002-8294-6507</orcidid><oa>free_for_read</oa></addata></record> |
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| 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 |
| title | Endoscopic management of colonic perforations: clips versus suturing closure (with videos) |
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