Surgical Endoscopy

, Volume 33, Issue 4, pp 1319–1325 | Cite as

Purse-string sutures using novel endoloops and repositionable clips for the closure of large iatrogenic duodenal perforations with single-channel endoscope: a multicenter study

  • Sumin Zhu
  • Jie Lin
  • Fazhen Xu
  • Simin Guo
  • Shu HuangEmail author
  • Min WangEmail author
Dynamic Manuscript



Serious complications due to perforation restrict the development of duodenal endoscopic treatment. The key stage for remediation is the successful endoscopic closure to prevent peritonitis and the need for surgical intervention. This report aimed to present a new simple method for the closure of large iatrogenic duodenal perforations with purse-string sutures using the novel endoloops and repositionable clips through a single-channel endoscope.


A total of 23 patients with iatrogenic duodenal perforations ≥ 1 cm were retrospectively studied who were presently treated by purse-string sutures using the novel endoloops and the repositionable hemostasis clips with the single-channel endoscope at four institutes. During and after the procedure, a 20-gauge needle was used to relieve the pneumoperitoneum or subcutaneous emphysema. Finally, a gastroduodenal decompression tube was placed.


The median maximum diameter of iatrogenic duodenal perforations was 1.65 cm (range 1.0–3.0 cm). Complete endoscopic closure of all 23 perforations was achieved. No patient had severe complications such as peritonitis. The wounds were healed and no obvious duodenal stricture was observed in all cases after 3 months.


Purse-string sutures using the novel endoloops and repositionable endoclips through single-channel endoscope were feasible, effective and easy methods for the closure of large duodenal iatrogenic perforations.


Endoscopic purse-string suture Duodenal perforation Single-channel endoscope 



This work is supported in part by the grants from Jiangsu Youth Medical Key Talents Cultivation (QNRC2016442) and Jiangsu dual creation project (2017-37).

Compliance with ethical standards


Sumin Zhu, Jie Lin, Fazhen Xu, Simin Guo, Shu Huang, and Min Wang have no conflict of interest or financial ties to disclose.

Supplementary material

Supplementary material 1—Video 1: Purse-string suture using the novel endoloop and repositionable clips to repair a duodenal defect from EFTR with single-channel endoscope (MP4 25327 KB)

464_2018_6586_MOESM2_ESM.pdf (5.9 mb)
Supplementary material 2 (PDF 6087 KB)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Medical Center for Digestive Diseases, The Second Affiliated HospitalNanjing Medical UniversityNanjingChina
  2. 2.Department of GastroenterologyGeneral Hospital of XuZhou Mining GroupXuzhouChina
  3. 3.Department of GastroenterologyThe People’s Hospital of LianshuiHuaianChina
  4. 4.Digestive Endoscopy Department, The First Affiliated HospitalNanjing Medical UniversityNanjingChina

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