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Management of scope-induced type I duodenal perforations: Over-the-scope clip versus surgery

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A Correction to this article was published on 17 November 2022

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Abstract

Background

Scope-induced duodenal perforation is a life-threatening complication and surgery remains the standard of care. With the advent of over-the-scope clip (OTSC), scope-induced perforations are increasingly managed conservatively, though there is no study comparing this form of non-surgical treatment with surgery. We aimed to compare OTSC and surgery in the management of scope-induced perforation of the duodenum.

Methods

We retrospectively collected data of scope-induced duodenal perforation patients. Perforations identified and treated within 24 h of procedure were analyzed. Factors analyzed were spectrum, etiology, baseline parameters, perforation size, outcome, comorbidities, and duration of hospital stay.

Results

A total of 25 patients had type I duodenal perforations, out of whom five were excluded due to delayed diagnosis and treatment. Of the twenty, eight were treated with OTSC placement while the rest underwent surgery. Age was comparable and the majority were females. Baseline parameters and comorbidities were similar in both the groups. The median size of perforation was 1.5 cm in both the OTSC group and the surgical group. All patients were treated with standard of care according to institutional protocols. Patients in the OTSC group were started orally after 48 h of OTSC placement, while in the surgery group median time to oral intake was 7 days. Two patients in the surgical group died while there was no mortality in the OTSC group (p = 0.48). Median hospital stay was shorter in the OTSC group (2 days vs. 22 days, p = 0.003).

Conclusions

OTSC is a feasible and better option in type I duodenal perforations with a shorter hospital stay.

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Acknowledgements

We acknowledge the Department of Radiology, G B Pant Institute of Postgraduate Medical Education and Research (GIPMER) for their enormous help, support, and clinical inputs for patient management.

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Authors and Affiliations

  1. Department of Gastroenterology, Dr. D Y Patil Medical College and Hospital, Pimpri, Pune, 411 018, India

    Amol S. Dahale

  2. Department of Gastroenterology, G B Pant Institute of Postgraduate Medical Education and Research, 1, J L N Marg, New Delhi, 110 002, India

    Siddharth Srivastava, Sanjeev Sachdeva, Ashok Dalal & Shivakumar Varakanahalli

  3. Department of Gastrointestinal Surgery, G B Pant Institute of Postgraduate Medical Education and Research, New Delhi, 110 002, India

    Sundeep Singh Saluja

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  1. Amol S. Dahale
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  2. Siddharth Srivastava
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Correspondence to Siddharth Srivastava.

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ASD, SS, SSS, SS, AD, and SV declare no competing interests.

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The study was performed conforming to the Helsinki declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on Springer.com.

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Dahale, A.S., Srivastava, S., Saluja, S.S. et al. Management of scope-induced type I duodenal perforations: Over-the-scope clip versus surgery. Indian J Gastroenterol 40, 287–294 (2021). https://doi.org/10.1007/s12664-021-01152-0

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  • DOI: https://doi.org/10.1007/s12664-021-01152-0

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