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Endoscopic management of colonic perforations: clips versus suturing closure (with videos).
Kantsevoy, Sergey V; Bitner, Marianne; Hajiyeva, Gulara; Mirovski, Paulina M; Cox, Michael E; Swope, Thomas; Alexander, Kelly; Meenaghan, Nora; Fitzpatrick, J Lawrence; Gushchin, Vadim.
Afiliación
  • Kantsevoy SV; Institute for Digestive Health and Liver Diseases, Mercy Medical Center, Baltimore, Maryland, USA; University of Maryland School of Medicine, Baltimore, Maryland, USA.
  • Bitner M; Institute for Digestive Health and Liver Diseases, Mercy Medical Center, Baltimore, Maryland, USA.
  • Hajiyeva G; Institute for Digestive Health and Liver Diseases, Mercy Medical Center, Baltimore, Maryland, USA; Harbor Hospital Center, Baltimore, Maryland, USA.
  • Mirovski PM; Institute for Digestive Health and Liver Diseases, Mercy Medical Center, Baltimore, Maryland, USA.
  • Cox ME; Institute for Digestive Health and Liver Diseases, Mercy Medical Center, Baltimore, Maryland, USA.
  • Swope T; Center for Minimally Invasive Surgery, Mercy Medical Center, Baltimore, Maryland, USA.
  • Alexander K; Center for Minimally Invasive Surgery, Mercy Medical Center, Baltimore, Maryland, USA.
  • Meenaghan N; Center for Minimally Invasive Surgery, Mercy Medical Center, Baltimore, Maryland, USA.
  • Fitzpatrick JL; Center for Minimally Invasive Surgery, Mercy Medical Center, Baltimore, Maryland, USA.
  • Gushchin V; Surgical Oncology, Mercy Medical Center, Baltimore, Maryland, USA.
Gastrointest Endosc ; 84(3): 487-93, 2016 Sep.
Article en En | MEDLINE | ID: mdl-26364965
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.
Asunto(s)

Texto completo: 1 Bases de datos: MEDLINE Asunto principal: Instrumentos Quirúrgicos / Técnicas de Sutura / Colonoscopía / Enfermedades del Colon / Perforación Intestinal Tipo de estudio: Etiology_studies / Observational_studies Límite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Gastrointest Endosc Año: 2016 Tipo del documento: Article País de afiliación: Estados Unidos

Texto completo: 1 Bases de datos: MEDLINE Asunto principal: Instrumentos Quirúrgicos / Técnicas de Sutura / Colonoscopía / Enfermedades del Colon / Perforación Intestinal Tipo de estudio: Etiology_studies / Observational_studies Límite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Gastrointest Endosc Año: 2016 Tipo del documento: Article País de afiliación: Estados Unidos