Skip to main content
SpringerLink
Log in

The Efficacy of a Novel Tissue Grasper-Clips Technique for Large Perforations of the Sigmoid Colon in an Experimental Animal Model (Video)

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background

The incidence of iatrogenic colonic perforation has been gradually increasing. In particular, sigmoid colon perforations are difficult to handle because of excess mobility.

Aim

The aim of this study was to evaluate the efficacy of the twin grasper-clips technique for large perforations of the sigmoid colon.

Methods

This study was designed as a prospective, randomized, experimental study using ex vivo porcine colorectal specimens. Thirty standardized and variable artificial perforations were closed in the hemoclip group (hemoclips) and twin grasper group (hemoclips with a novel tissue grasper). We counted the number of hemoclips used per case to assess the cost and efficacy of the procedure.

Results

In the hemoclip group (n = 15), among the 20-, 25-, and 30-mm defects, the mean number of clips (4.8 ± 0.8, 6.0 ± 1.6, and 8.4 ± 2.1, respectively, p = 0.011) and closure time (7.6 ± 0.5, 9.9 ± 3.3, and 13.9 ± 4.1 min, respectively, p = 0.020) differed significantly. In the twin grasper group (n = 15), among the 20-, 25-, and 30-mm defects, the mean number of clips (4.0 ± 1.0, 5.0 ± 0.7, and 5.4 ± 1.1, respectively, p = 0.101) and closure time (7.7 ± 0.6, 8.3 ± 1.9, and 9.1 ± 2.7 min, respectively, p = 0.506) did not differ significantly. In 30-mm defects, the mean number of hemoclips used per case and total closure time were significantly lower in the twin grasper group than the hemoclip group.

Conclusions

The twin grasper-clips technique seems to reduce the use of hemoclips and to result in more effective and rapid closure than does the conventional technique in large perforations of the ex vivo porcine sigmoid colon.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Panteris V, Haringsma J, Kuipers EJ. Colonoscopy perforation rate, mechanisms and outcome: from diagnostic to therapeutic colonoscopy. Endoscopy. 2009;41:941–951.

    Article  CAS  PubMed  Google Scholar 

  2. Cobb WS, Heniford BT, Sigmon LB, et al. Colonoscopic perforations: incidence, management, and outcomes. Am Surg. 2004;70:750–757. (discussion 757–758).

    PubMed  Google Scholar 

  3. Wullstein C, Koppen M, Gross E. Laparoscopic treatment of colonic perforations related to colonoscopy. Surg Endosc. 1999;13:484–487.

    Article  CAS  PubMed  Google Scholar 

  4. Anderson M, Pasha T, Leighton J. Endoscopic perforation of the colon: lessons from a 10-year study. Am J Gastroenterol. 2000;95:3418–3422.

    Article  CAS  PubMed  Google Scholar 

  5. Mana F, De Vogelaere K, Urban D. Iatrogenic perforation of the colon during diagnostic colonoscopy: endoscopic treatment with clips. Gastrointest Endosc. 2001;54:258–259.

    Article  CAS  PubMed  Google Scholar 

  6. Celestino C, Harz C, Decaestecker J, Saenz R. Endoscopic treatment of an iatrogenic perforation of the colon by using endoloop. Gastrointest Endosc. 2006;64:653–654.

    Article  PubMed  Google Scholar 

  7. Gosen C, Poulose B, Trunzo J, Marks J. Endoscopic management of iatrogenic colon perforation during colonoscopy. Am Surg. 2009;75:184–186.

    PubMed  Google Scholar 

  8. Raju GS, Saito Y, Matsuda T, Kaltenbach T, Soetikno R. Endoscopic management of colonoscopic perforations (with videos). Gastrointest Endosc. 2011;74:1380–1388.

    Article  PubMed  Google Scholar 

  9. Levin T, Zhao W, Conell C, et al. Complications of colonoscopy in an integrated health care delivery system. Ann Intern Med. 2006;145:880–886.

    Article  PubMed  Google Scholar 

  10. Rabeneck L, Paszat LF, Hilsden RJ, et al. Bleeding and perforation after outpatient colonoscopy and their risk factors in usual clinical practice. Gastroenterology. 2008;135:1899–1906, 1906 and 1891.

  11. Singh H, Penfold RB, DeCoster C, et al. Colonoscopy and its complications across a Canadian regional health authority. Gastrointest Endosc. 2009;69:665–671.

    Article  PubMed  Google Scholar 

  12. Yoshikane H, Hidano H, Sakakibara A, et al. Endoscopic repair by clipping of iatrogenic colonic perforation. Gastrointest Endosc. 1997;46:464–466.

    Article  CAS  PubMed  Google Scholar 

  13. Yang D-H, Byeon J-S, Lee K-H, et al. Is endoscopic closure with clips effective for both diagnostic and therapeutic colonoscopy-associated bowel perforation? Surg Endosc. 2010;24:1177–1185.

    Article  PubMed  Google Scholar 

  14. Cho SB, Lee WS, Joo YE, et al. Therapeutic options for iatrogenic colon perforation: feasibility of endoscopic clip closure and predictors of the need for early surgery. Surg Endosc. 2012;26:473–479.

    Article  PubMed  Google Scholar 

  15. Magdeburg RCP, Post S, Kaehler G. Endoclipping of iatrogenic colonic perforation to avoid surgery. Surg Endosc. 2008;22:1500–1504.

    Article  PubMed  Google Scholar 

  16. Avgerinos DV, Llaguna OH, Lo AY, Leitman IM. Evolving management of colonoscopic perforations. J Gastrointest Surg. 2008;12:1783–1789.

    Article  PubMed  Google Scholar 

  17. Jovanovic I, Zimmermann L, Fry LC, Mönkemüller K. Feasibility of endoscopic closure of an iatrogenic colon perforation occurring during colonoscopy. Gastrointest Endosc. 2011;73:550–555.

    Article  PubMed  Google Scholar 

  18. von Renteln D, Schmidt A, Vassiliou MC, Rudolph HU, Gieselmann M, Caca K. Endoscopic closure of large colonic perforations using an over-the-scope clip: a randomized controlled porcine study. Endoscopy. 2009;41:481–486.

    Article  Google Scholar 

  19. von Renteln D, Vassiliou MC, Rothstein RI. Randomized controlled trial comparing endoscopic clips and over-the-scope clips for closure of natural orifice transluminal endoscopic surgery gastrotomies. Endoscopy. 2009;41:1056–1061.

    Article  Google Scholar 

  20. Matthes K, Jung Y, Kato M, Gromski MA, Chuttani R. Efficacy of full-thickness GI perforation closure with a novel over-the-scope clip application device: an animal study. Gastrointest Endosc. 2011;74:1369–1375.

    Article  PubMed  Google Scholar 

  21. Voermans RP, Le Moine O, von Renteln D, et al. Efficacy of endoscopic closure of acute perforations of the gastrointestinal tract. Clin Gastroenterol Hepatol. 2012;10:603–608.

    Article  PubMed  Google Scholar 

  22. Baron TH, Song LM, Ross A, Tokar JL, Irani S, Kozarek RA. Use of an over-the-scope clipping device: multicenter retrospective results of the first U.S. experience (with videos). Gastrointest Endosc. 2012;76:202–208.

    Article  PubMed  Google Scholar 

  23. Katsinelos P, Kountouras J, Chatzimavroudis G, et al. Endoscopic closure of a large iatrogenic rectal perforation using endoloop/clips technique. Acta Gastroenterol Belg. 2009;72:357–359.

    CAS  PubMed  Google Scholar 

  24. Kantsevoy SV, Bitner M, Mitrakov AA, Thuluvath PJ. Endoscopic suturing closure of large mucosal defects after endoscopic submucosal dissection is technically feasible, fast, and eliminates the need for hospitalization (with videos). Gastrointest Endosc. 2014;79:503–507.

    Article  PubMed  Google Scholar 

  25. Pauli EM, Delaney CP, Champagne B, Stein S, Marks JM. Safety and effectiveness of an endoscopic suturing device in a human colonic treat-and-resect model. Surg Innov. 2013;20:594–599.

    Article  PubMed  Google Scholar 

  26. Kantsevoy SV, Bitner M, Hajiyeva G, et al. Endoscopic management of colonic perforations: clips versus suturing closure (with videos). Gastrointest Endosc. 2016;84:487–493.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This work was supported by the Soonchunhyang University Research Fund.

Author information

Authors and Affiliations

  1. Division of Gastroenterology, Department of Medicine, Soonchunhyang University College of Medicine, 23-20 Bongmyung-dong, Dongnam-gu, Cheonan-si, Chungcheongnam-do, South Korea

    Jun Young Eun, Yunho Jung, Tae Hoon Lee, Young Sin Cho, Ho Sung Rhee, Young Kyu Jung, Duk Su Kim, Il Kwun Chung, Sang-Heum Park & Sun Joo Kim

  2. Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, South Korea

    Joung-Ho Han

Authors
  1. Jun Young Eun
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yunho Jung
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tae Hoon Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Young Sin Cho
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ho Sung Rhee
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Young Kyu Jung
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Joung-Ho Han
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Duk Su Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Il Kwun Chung
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Sang-Heum Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Sun Joo Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yunho Jung.

Ethics declarations

Conflict of interest

None.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (WMV 24107 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Eun, J.Y., Jung, Y., Lee, T.H. et al. The Efficacy of a Novel Tissue Grasper-Clips Technique for Large Perforations of the Sigmoid Colon in an Experimental Animal Model (Video). Dig Dis Sci 62, 913–921 (2017). https://doi.org/10.1007/s10620-017-4483-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-017-4483-4

Keywords

Search

Navigation