Single-channel endoscopic closure of large endoscopy-related perforations

Background and study aims: Gastrointestinal endoscopy procedures, such as endoscopic retrograde cholangiopancreatography (ERCP), endoscopic submucosal dissection (ESD), and colonoscopy are widely used for the diagnosis or treatment of digestive diseases. Perforation is a rare but potentially lethal complication. Large perforations usually require immediate endoscopic or surgical repair. Endoscopic closure using a nylon loop pouch suture is usually performed with a double-channel endoscope. This paper describes the endoscopic closure of large procedure-related perforations using a single-channel endoscope.

Patients and methods: A total of 10 patients with large perforations (2.5 – 4.0 cm), which occurred during ERCP, ESD, or colonoscopy, were treated using the single-channel endoscope technique.

Results: All perforations were successfully closed using a nylon loop pouch suture through the single-channel endoscope. No surgery or further endoscopic intervention was required.

Conclusions: Nylon loop pouch suture through a single-channel endoscope was easy to perform and was feasible for the closure of large gastrointestinal perforations.

• References

• 1 Loperfido S, Angelini G, Benedetti G et al. Major early complications from diagnostic and therapeutic ERCP: a prospective multicenter study. Gastrointest Endosc 1998; 48: 1-10
• 2 Salminen P, Laine S, Gullichsen R. Severe and fatal complications after ERCP: analysis of 2555 procedures in a single experienced center. Surg Endosc 2008; 22: 1965-1970
• 3 Assimakopoulos SF, Thomopoulos KC, Giali S et al. A rare etiology of post-endoscopic retrograde cholangiopancreatography pneumoperitoneum. World J Gastroenterol 2008; 14: 2917-2919
• 4 Fujii L, Lau A, Fleischer DE et al. Successful nonsurgical treatment of pneumomediastinum, pneumothorax, pneumoperitoneum, pneumoretroperitoneum, and subcutaneous emphysema following ERCP. Gastroenterol Res Pract 2010; 2010 289135
• 5 Paspatis GA, Dumonceau JM, Barthet M et al. Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) position statement. Endoscopy 2014; 46: 693-711
• 6 Jeon SW, Jung MK, Kim SK et al. Clinical outcomes for perforations during endoscopic submucosal dissection in patients with gastric lesions. Surg Endosc 2010; 24: 911-916
• 7 Parlak E, Disibeyaz S, Köksal AS et al. A new approach to gastrointestinal fistula closure: endoloop and clips technique using double endoscope. Eur J Gastroenterol Hepatol 2012; 24: 464-467
• 8 Lee TH, Bang BW, Jeong JI et al. Primary endoscopic approximation suture under cap-assisted endoscopy of an ERCP-induced duodenal perforation. World J Gastroenterol 2010; 16: 2305
• 9 Donatelli 1st G, Vergeau BM, Dritsas S et al. Closure with an over-the-scope clip allows therapeutic ERCP to be safely performed after acute duodenal perforation during diagnostic endoscopic ultrasound. Endoscopy 2013; 45: E392-E393
• 10 Merchea A, Cullinane DC, Sawyer MD et al. Esophagogastroduodenoscopy-associated gastrointestinal perforations: a single-center experience. Surgery 2010; 148: 876-880
• 11 Nakagawa Y, Nagai T, Soma W et al. Endoscopic closure of a large ERCP-related duodenal perforation by using endoloops and endoclips. Gastrointest Endosc 2010; 72: 216-217
• 12 Ercan M, Bostanci EB, Dalgic T et al. Surgical outcome of patients with perforation after endoscopic retrograde cholangiopancreatography. J Laparoendosc Adv Surg Tech A 2012; 22: 371-377
• 13 Yoshida N, Yagi N, Inada Y et al. Prevention and management of complications of and training for colorectal endoscopic submucosal dissection. Gastroenterol Res Pract 2013; 287173
• 14 Yoshida N, Yagi N, Naito Y et al. Safe procedure in endoscopic submucosal dissection for colorectal tumors focused on preventing complications. World J Gastroenterol 2010; 16: 1688-1695
• 15 Hamdani U, Naeem R, Haider F et al. Risk factors for colonoscopic perforation: a population-based study of 80118 cases. World J Gastroenterol 2013; 19: 3596-3601
• 16 Celestino C, Harz C, Decaestecker J et al. Endoscopic treatment of an iatrogenic perforation of the colon by using endoloop. Gastrointest Endosc 2006; 64: 653-654