Successful Endoscopic Closure of Iatrogenic Esophageal Perforation During ERCP

Gastrointestinal perforations pose a significant therapeutic challenge. While surgery is traditional, advancements in endoscopic techniques, particularly Over-The-Scope Clip (OTS-clip) systems, now allow effective closure of perforations up to 2 cm.

A 79-year-old male with borderline pancreatic head adenocarcinoma, undergoing chemotherapy, was admitted for obstructive jaundice due to suspected biliary stent dysfunction. Within 24 hours, the patient developed hematemesis and anemia. Gastroscopy revealed a bleeding, ulcerated major papilla. Despite hemostatic interventions, the bleeding recurred after 48 hours. A CT scan and angiography identified a pathological artery supplying the tumor adjacent to the bile duct, which was successfully embolized.

To resolve the obstructive jaundice, an ERCP was performed. During endoscopy, an iatrogenic perforation of approximately 15 mm occurred in the distal esophagus. Immediate endoscopic closure was achieved using an OTS-clip system. Due to patient’s clinical and hemodynamic stability and the prompt closure of the perforation, the procedure was completed. The common bile duct was full cleared of clots, and an uncovered metal biliary stent was placed.

The patient was discharged 10 days later, asymptomatic and without any other complications.

OTS-clip systems are effective devices for the rapid and straightforward closure of acute perforations. They allow for the safe continuation of prolonged and complex endoscopic procedures, as demonstrated in this case.

Publication History

Article published online:
27 March 2025