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Endoscopic closure of iatrogenic colon perforation using dual-channel endoscope with an endoloop and clips: methods and feasibility data (with videos)

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Abstract

Background

Colon perforation is the most serious complication associated with colonoscopic procedures. We performed a novel purse-string suture technique to close the iatrogenic colonic perforation using dual-channel endoscope with an endoloop and clips.

Methods

Iatrogenic colon perforations developed during diagnostic colonoscopy referred to a tertiary hospital over 10 years were considered for this endoscopic closure. An endoloop was inserted through the left channel of the endoscope and placed around the defect. The first clip was placed at the proximal site of the defect through the other channel of the endoscope, and the endoloop was anchored on the mucosa around the defect. Then, subsequent clips were placed next to previous clips and the endoloop was fixed. After the defect was encircled by the endoloop and clips, the rim of the opening was approximated by fastening the endoloop with a purse-string technique.

Results

A total of 8 patients were admitted to our hospital because of iatrogenic colon perforations during diagnostic colonoscopy. Of these, 2 underwent laparoscopic surgery and 6 underwent endoscopic closure by this novel purse-string suture technique. The estimated diameters of the perforations were 20 mm. All cases were successfully treated in the endoscopy unit without sedation or general anesthesia, and recovered without any complication or subsequent operation. Abdominal pain had nearly resolved within 3 days after the procedure in all patients, and only mild peritonitis was observed.

Conclusions

Iatrogenic colon perforation can be treated with a purse-string suture technique using dual-channel endoscope with an endoloop and clips. This technique can be useful for relatively large colon perforations associated with diagnostic colonoscopy.

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Funding

This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MEST) (No. 2017R1D1A1B03031924).

Author information

Author notes

  1. Ja Young Ryu and Byung Kwan Park have contributed equally to this work.

Authors and Affiliations

  1. Department of Internal Medicine, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, Republic of Korea

    Ja Young Ryu, Won-Seok Kim, Kisung Kim, Jae Young Lee, Young Kim, Jae Yong Park, Beom Jin Kim, Jeong Wook Kim & Chang Hwan Choi

  2. Department of Surgery, Chung-Ang University College of Medicine, Seoul, Republic of Korea

    Byung Kwan Park

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  1. Ja Young Ryu
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Corresponding author

Correspondence to Chang Hwan Choi.

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Disclosures

Ja Young Ryu, Byung Kwan Park, Won-Seok Kim, Kisung Kim, Jae Young Lee, Young Kim, Jae Yong Park, Beom Jin Kim, Jeong Wook Kim, and Chang Hwan Choi have no conflicts of interest or financial ties to disclose.

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Endoscopic closure of iatrogenic colon perforation using dual-channel endoscope with an endoloop and clips in case #1. Supplementary material 1 (MP4 42695 KB)

Endoscopic closure of iatrogenic colon perforation using dual-channel endoscope with an endoloop and clips in case #2. Supplementary material 2 (MP4 29114 KB)

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Ryu, J.Y., Park, B.K., Kim, WS. et al. Endoscopic closure of iatrogenic colon perforation using dual-channel endoscope with an endoloop and clips: methods and feasibility data (with videos). Surg Endosc 33, 1342–1348 (2019). https://doi.org/10.1007/s00464-018-06616-7

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