Details

Autor(en) / Beteiligte

• Voermans, Rogier P
• Le Moine, Olivier
• von Renteln, Daniel
• Ponchon, Thierry
• Giovannini, Marc
• Bruno, Marco
• Weusten, Bas
• Seewald, Stefan
• Costamagna, Guido
• Deprez, Pierre
• Fockens, Paul

Titel

Efficacy of Endoscopic Closure of Acute Perforations of the Gastrointestinal Tract

Ist Teil von

• Clinical gastroenterology and hepatology, 2012-06, Vol.10 (6), p.603-608

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2012

Quelle

MEDLINE

Beschreibungen/Notizen

• Background & Aims Acute perforations of the gastrointestinal tract are rare, severe complications of endoscopy that usually require surgical repair. Endoscopic repair of perforations would reduce the need for surgeries; we evaluated the efficacy and safety of endoscopic closure of acute perforations of the gastrointestinal tract by using a new clip device. Methods We conducted a prospective, international, multicenter study of 36 consecutive patients (15 male) with acute iatrogenic perforations (5 esophageal, 6 gastric, 12 duodenal, and 13 colonic perforation). Endoscopic repair was performed by using the Over-the-Scope-Clip according to a standardized operating procedure. Primary end point was successful closure, which was determined as endoscopic successful closure without leakage (detected by water-soluble contrast x-ray analysis), and absence of adverse events within 30 days after the procedure. Results Immediate closure was endoscopically successful in 33 patients (92%). One patient developed an esophageal perforation while the cap was introduced, and in 2 patients the perforations did not close; these 3 patients were successfully treated with surgery. None of the patients had leakage of soluble contrast on the basis of contrast x-ray. One patient with a closed colonic perforation deteriorated clinically within 6 hours after the procedure. Despite surgery, the patient died within 36 hours. The remaining 32 patients had successful endoluminal closures; the overall success rate was 89% (95% confidence interval, 75%–96%). The mean endoscopic closure time was 5 minutes 44 seconds ± 4 minutes 15 seconds. Conclusions The Over-the-Scope-Clip is effective for endoluminal closure of acute iatrogenic perforations. It allows patients to avoid surgery, and 89% of patients had successful closures without adverse events.