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Closure of gastrointestinal perforations using an endoloop system and a single-channel endoscope: description of a simple, reproducible, and standardized method

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Abstract

Background

Several endoscopic treatments for iatrogenic perforations are currently available, with some limitations in terms of size, location, complexity, or cost. Our aims were to introduce a novel technique for closure, using an endoloop and clips, to assess its rate of technical success and post-resection complications.

Methods

For closure of large perforations (diameter ≥ 10 mm), two similar techniques were implemented, using a single-channel endoscope. An endoloop was deployed through the operating channel or towed by an endoclip alongside the endoscope. Several clips were utilized to fix it on the muscular layer of defect’s margins. The defect was closed, by fastening the loop either directly or after being reattached to the mobile hook.

Results

This analysis included eleven patients (72% women, median age 68 years). Eight colorectal, one appendiceal, and two gastric lesions were resected, with a median perforation size of 15 mm. As confirmed by computed tomography, closure of wall defects was achieved successfully in all cases, using a median of 6 clips. Pneumoperitoneum was evacuated in 4 cases. The median hospitalization duration was 4 days, prophylactic antibiotics being prescribed for a median of 7 days. One patient had a small abdominal collection, without requiring drainage, while another presented post-resection bleeding from the mucosal defect.

Conclusion

The novel techniques, utilizing a single-channel endoscope, clips, and an endoloop, ensuring an edge-to-edge suture of muscular layer, proved to be safe, reproducible, and easy to implement. They exhibit an excellent technical success rate and a minimal incidence of non-severe complications.

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Acknowledgements

Partial results of this study were presented as a poster at European Society of Gastrointestinal Endoscopy (ESGE) Days, 20-22 April 2023, Dublin, Ireland.

Funding

No support in the form of grants, equipment, drugs, for all of the above.

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Authors and Affiliations

  1. Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France

    Flavius-Stefan Marin, Antoine Assaf, Paul Doumbe-Mandengue, Einas Abou Ali, Arthur Belle, Romain Coriat & Stanislas Chaussade

  2. University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania

    Flavius-Stefan Marin

  3. Faculty of Medicine, The University of Paris Cité, Paris, France

    Antoine Assaf, Romain Coriat & Stanislas Chaussade

Authors
  1. Flavius-Stefan Marin
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  2. Antoine Assaf
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  4. Einas Abou Ali
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  5. Arthur Belle
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Contributions

F-SM: data curation (lead), methodology (equal), formal analysis (lead), visualization (lead), writing—original draft preparation (lead). AA: data curation (equal), visualization (equal), writing—review & editing (equal), PD-M: data curation (equal), visualization (equal), writing—review & editing (equal). EAA: methodology (equal), writing—review & editing (equal). AB: writing—review & editing (equal). RC: writing—review & editing (equal). SC: methodology (lead). conceptualization (lead). writing—review & editing (lead).

Corresponding author

Correspondence to Flavius-Stefan Marin.

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Disclosure

Stanislas Chaussade received honoraria for lectures, presentations or educational events from FujiFilm and Duomed France. No support in the form of grants, equipment, drugs, for all of the above. Flavius-Stefan Marin, Antoine Assaf, Paul Doumbe-Mandengue, Einas Abou Ali, Arthur Belle and Romain Coriat have no conflicts of interest to disclose.

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Supplementary Information

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Supplementary file1: Video 1: Example of perforation closure with endoloop, endoclips and single channel colonoscope. (MP4 1,03,420 kb)

Supplementary file1 (DOCX 35 kb)

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Marin, FS., Assaf, A., Doumbe-Mandengue, P. et al. Closure of gastrointestinal perforations using an endoloop system and a single-channel endoscope: description of a simple, reproducible, and standardized method. Surg Endosc 38, 1600–1607 (2024). https://doi.org/10.1007/s00464-023-10654-1

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