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Familiari P, Landi R, Costamagna G. Stenting and Endoscopic Techniques Alternative to POEM for Achalasia. GASTROINTESTINAL AND PANCREATICO-BILIARY DISEASES: ADVANCED DIAGNOSTIC AND THERAPEUTIC ENDOSCOPY 2022:591-604. [DOI: 10.1007/978-3-030-56993-8_34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Ge PS, Raju GS. Rupture and Perforation of the Esophagus. THE ESOPHAGUS 2021:769-788. [DOI: 10.1002/9781119599692.ch45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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Angsuwatcharakon P, Rerknimitr R. Endoscopic closure of iatrogenic perforation. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2016. [DOI: 10.18528/gii150009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Phonthep Angsuwatcharakon
- Department of Anatomy, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Rungsun Rerknimitr
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
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Yan B, Shi RH, Feng YD, Di ZH. Evaluating long-term attachment of a novel endoclip in porcine stomachs: a prospective study of initial deployment success and clip retention rates at different regions of the stomachs. Surg Endosc 2016; 30:1100-1106. [PMID: 26092025 DOI: 10.1007/s00464-015-4305-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 05/26/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Through-the-scope endoscopic clips are widely used. Several designs of endoscopic clips are marked for different applications. However, no prior reports have been published to aid in comparing success rates of clip deployment and the retention rates at different regions of the stomachs. The aims of the article were to compare success rates of clip deployment and the retention rates at different regions of the stomachs with a novel endoclip. METHODS Upper endoscope was inserted into the stomach of five pigs under general anesthesia. In all animals, three regions of the stomachs (gastric fundus, gastric body, and gastric antrum) were chosen as the sites of clip application. Two clips of a novel type were placed along the same gastric site at a distance of 0.5-1 cm from each other. Animals had weekly endoscopies to quantitate clip retention. RESULTS Success rates of clip deployment were 70% for gastric fundus, 100% for gastric body, and 100% for gastric antrum. Clip retention rates were significantly higher with gastric body than with gastric fundus or gastric antrum at 1-8 weeks. CONCLUSIONS (1) For the clip device, it seems that it is difficult for the clip deployment in gastric fundus (70%) than that in the gastric body or gastric antrum (100%), but there is no statistical significance (χ (2) test, p = 0.21). (2) Clips used in the gastric body were retained significantly longer than that in the gastric fundus or gastric antrum. (3) The novel clips were safe, and no complications such as bleeding or weight loss were noted.
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Affiliation(s)
- Bo Yan
- Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, Jiangsu, China.
| | - Rui-Hua Shi
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Ya-Dong Feng
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Zhen-Hai Di
- Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, Jiangsu, China.
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Lázár G, Paszt A, Mán E. Role of endoscopic clipping in the treatment of oesophageal perforations. World J Gastrointest Endosc 2016; 8:13-22. [PMID: 26788259 PMCID: PMC4707319 DOI: 10.4253/wjge.v8.i1.13] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 09/25/2015] [Accepted: 11/11/2015] [Indexed: 02/06/2023] Open
Abstract
With advances in endoscopic technologies, endoscopic clips have been used widely and successfully in the treatment of various types of oesophageal perforations, anastomosis leakages and fistulas. Our aim was to summarize the experience with two types of clips: The through-the-scope (TTS) clip and the over-the-scope clip (OTSC). We summarized the results of oesophageal perforation closure with endoscopic clips. We processed the data from 38 articles and 127 patients using PubMed search. Based on evidence thus far, it can be stated that both clips can be used in the treatment of early (< 24 h), iatrogenic, spontaneous oesophageal perforations in the case of limited injury or contamination. TTS clips are efficacious in the treatment of 10 mm lesions, while bigger (< 20 mm) lesions can be treated successfully with OTSC clips, whose effectiveness is similar to that of surgical treatment. However, the clinical success rate is significantly lower in the case of fistulas and in the treatment of anastomosis insufficiency. Tough prospective randomized multicentre trials, which produce the largest amount of evidence, are still missing. Based on experience so far, endoscopic clips represent a possible therapeutic alternative to surgery in the treatment of oesophageal perforations under well-defined conditions.
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Abstract
Gastrointestinal leaks and fistulae are common postoperative complications, whereas intestinal perforation more commonly complicates advanced endoscopic procedures. Although these complications have classically been managed surgically, there exists an ever-expanding role for endoscopic therapy and the involvement of advanced endoscopists as part of a multidisciplinary team including surgeons and interventional radiologists. This review will serve to highlight the innovative endoscopic interventions that provide an expanding range of viable endoscopic approaches to the management and therapy of gastrointestinal perforation, leaks, and fistulae.
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Propst EJ, Ling SC, Daneman A, Langer JC. Endoscopic clip for closure of persistent tracheoesophageal fistula in an infant. Laryngoscope 2014; 124:2182-5. [PMID: 25295352 DOI: 10.1002/lary.24650] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Enterocutaneous Fistula From A Billroth II Afferent Limb: Successful Closure With Endoclips. ACG Case Rep J 2014; 1:76-8. [PMID: 26157830 PMCID: PMC4435281 DOI: 10.14309/crj.2014.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 01/02/2014] [Indexed: 12/13/2022] Open
Abstract
Recently, indications for endoscopic clips have expanded to include closure of gastrointestinal fistulae and perforations. A 62-year-old man with remote history of surgery for peptic ulcer underwent right hemicolectomy for a large hepatic flexure mass with proximal colonic dilatation. During surgery, inadvertent pinpoint duodenotomy of the afferent Billroth II limb resulted in a duodeno-cutaneous fistula. Despite total parental nutrition, cutaneous bile drainage persisted. The duodenal fistula was closed during upper endoscopy using three endoclips. Cutaneous bile drainage stopped, and the abdominal wall defect healed. This is the first published case of endoclip closure of an iatrogenic duodenal fistula from a Billroth II afferent limb.
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An JS, Baek IH, Chun SY, Kim KO. Successful endoscopic band ligation of esophageal perforation by fish bone ingestion. J Laparoendosc Adv Surg Tech A 2013; 23:459-62. [PMID: 23560657 DOI: 10.1089/lap.2013.0082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Acute esophageal perforations by foreign body ingestion result in complications such as mediastinitis and retropharyngeal or parapharyngeal abscesses. Because the mortality of esophageal perforation is up to 22%, immediate treatment is critical. Herein, we report a case of successful endoscopic band ligation of esophageal perforation. A 68-year-old man was admitted complaining of substernal pain and dysphagia after ingesting a fish bone. Immediately emergency endoscopy was performed, and the fish bone was observed lodged in the lower esophagus. Although the fish bone was easily removed by an endoscopic rat-tooth forceps, esophageal perforation was found after the procedure. Endoscopic band ligation for perforation was performed. Initial chest computed tomography (CT) showed pneumomediastinum and local inflammation, but follow-up CT showed improved pneumomediastinum. The patient was given oral nutrition 2 weeks after procedure, and he was discharged without any complications. This case report emphasizes for the first time the availability of immediate endoscopic band ligation for acute esophageal perforation.
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Affiliation(s)
- Jung Sun An
- Department of Internal Medicine, Division of Gastroenterology, Hallym University Sacred Heart Hospital, Anyang, Korea
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Dişibeyaz S, Köksal AŞ, Parlak E, Torun S, Şaşmaz N. Endoscopic closure of gastrointestinal defects with an over-the-scope clip device. A case series and review of the literature. Clin Res Hepatol Gastroenterol 2012; 36:614-21. [PMID: 22704818 DOI: 10.1016/j.clinre.2012.04.015] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Revised: 04/25/2012] [Accepted: 04/27/2012] [Indexed: 02/06/2023]
Abstract
BACKGROUND The over-the-scope clip (OTSC) is a novel endoscopic tool used in the non surgical treatment of gastrointestinal perforations, fistula, and anastomotic leaks. AIMS The aim of the present study was to evaluate the therapeutic efficacy of this new endoscopic device on anastomotic postsurgical leak and fistulas or GI perforation in a tertiary referral center. PATIENTS AND METHODS The study group consisted of nine patients (three female, six male, age: 22-65 years). The indications were anastomotic leak in five patients, fistula in three patients, and perforation in one patient. Atraumatic version of OTSCs with medium sized caps, twin graspers and anchor were used. All of the patients were treated with only one OTSC. None of the patients underwent additional endoscopic treatments. RESULTS The median size of the defects were 15 mm (range 5-20 mm). OTSC was favourable in five of nine patients (three with leak, and one with fistula and perforation, each). OTSC could not be deployed or partially closed the defect in the remaining four patients because of fibrosis at the edges of the defect. Excluding the case with perforation, the median time elapsed between the diagnosis and the placement of OTSC was 35 days (range: 20-80) in the successful group and 70 days (range: 38-94) in the unsuccessful group. There were no complications due to the OTSC application or the applicator cap. CONCLUSIONS OTSC is a safe and effective device for closure of perforations and leaks. However therapeutic efficacy is lower in cases with fistulas mainly due to associated fibrosis at the borders.
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Affiliation(s)
- Selçuk Dişibeyaz
- Türkiye Yüksek İhtisas Hospital, Department of Gastroenterology, Ankara, Turkey
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Successful endoscopic clipping in the early treatment of spontaneous esophageal perforation. Surg Laparosc Endosc Percutan Tech 2012; 21:e311-2. [PMID: 22146179 DOI: 10.1097/sle.0b013e31823118ee] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Barogenic esophageal injury or Boerhaave syndrome is an esophageal perforation entailing very high mortality and morbidity. Endoscopic techniques have been introduced in the treatment of various types of esophageal perforation. This report describes the first patient who underwent a successful endoscopic clipping involving sealing of a transpleural esophageal rupture within 24 hours of the onset of symptoms.
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Abstract
OPINION STATEMENT Esophageal perforation is an uncommon, potentially disastrous occurrence with high mortality rates even when managed with surgery. Over the past few decades, several case series have shown that nonoperative management is a feasible option in some patients, although the criteria for selecting such patients are neither firmly established nor accepted by all those who manage these critical patients. The decision to manage a patient without surgery should be made collaboratively with a surgeon. No single criterion, with the possible exception of sepsis and shock, mandates surgical management. Randomized, prospective studies comparing surgical and nonsurgical therapy have not been performed. Factors that can affect the decision to proceed nonoperatively include the perforation's site and size, the patient's underlying comorbidities, and the patient's hemodynamic status on presentation. Healthy patients with small, contained perforations who present without sepsis tend to be the best candidates for nonoperative management. Intravenous antibiotics and cessation of oral intake should be instituted immediately, even before confirming the diagnosis. Mediastinal fluid collections and pleural effusions often coexist with esophageal perforations and must be managed concomitantly. Percutaneously placed drains are an important adjunct to therapy when collections are identified. Endoscopic stenting has been introduced as a means to seal the perforation. After embarking on a nonoperative course, patients still may deteriorate and require surgery, so close follow-up is warranted for every patient. When proper nonoperative management strategies are followed, outcomes have been shown to be at least equivalent to those of surgical management in most series. In this review, the principles of patient selection and medical therapy for iatrogenic esophageal perforations are discussed.
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Affiliation(s)
- Ryan D Madanick
- Division of Gastroenterology and Hepatology, Center for Esophageal Diseases and Swallowing (CEDAS), University of North Carolina School of Medicine, 130 Mason Farm Road, Campus Box #7080 Bioinformatics 4142, Chapel Hill, NC, 27599, USA.
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Schrijver AM, Siersema PD, Vleggaar FP, Hirdes MMC, Monkelbaan JF. Endoclips for fixation of nasoenteral feeding tubes: a review. Dig Liver Dis 2011; 43:757-61. [PMID: 21482207 DOI: 10.1016/j.dld.2011.02.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Revised: 02/22/2011] [Accepted: 02/24/2011] [Indexed: 12/11/2022]
Abstract
BACKGROUND Maintaining the position of an endoscopically placed nasoenteral feeding tube beyond the pylorus is often problematic because of retrograde migration. Fixation of a feeding tube to the small intestinal wall with an endoclip may prevent this. This article reviews available literature on the feasibility, efficacy and safety of endoclips for fixation of nasoenteral feeding tubes. METHODS A systematic search of the English literature was performed using MEDLINE, EMBASE and Cochrane databases to identify articles assessing the use of endoclips for fixation of feeding tubes, as well as articles assessing duration of attachment of endoclips. RESULTS Five cohort series were identified that evaluated the applicability of endoclips for fixation of feeding tubes to the small intestinal wall. In all patients, except one, a nasoenteral feeding tube could be successfully fixated to the small intestinal wall. During follow-up, no spontaneous migrations of feeding tubes were observed. No complications related to placement or removal of endoclips were observed. Three comparative studies evaluated duration of attachment of different types of endoclips to the gastrointestinal wall. Duration of attachment ranged from less than 1 week to more than 18 weeks, depending on the type of endoclip. CONCLUSIONS Based on available literature the use of endoclips for fixation of nasoenteral feeding tubes is feasible, effective and safe. Data from randomized controlled trials are needed.
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Affiliation(s)
- A M Schrijver
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, The Netherlands
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Abstract
PURPOSE OF REVIEW Understanding the role of endoscopic closure techniques helps in expanding the endoscopist's role in the management of gastrointestinal neoplasia and explore new frontiers of minimally invasive endoluminal surgery. RECENT FINDINGS This article covers recent advances in endoscopic closure of various gastrointestinal perforations, with a special focus on devices, experimental evidence and clinical outcomes of endoscopic closure of gastrointestinal perforations. SUMMARY Endoscopic closure techniques help the endoscopist to walk on thin ice and save himself and the patient in the case of mishap.
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Lázár G, Paszt A, Simonka Z, Bársony A, Abrahám S, Horváth G. A successful strategy for surgical treatment of Boerhaave's syndrome. Surg Endosc 2011. [PMID: 21674208 DOI: 10.1007/s00464-011-1767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND This retrospective single-institution study presents a successful treatment strategy for Boerhaave's syndrome. METHODS During 1995-2008, 15 patients with spontaneous esophageal perforation were treated. Patients were grouped according to time from symptoms to referral (early, <24 h; late, >24 h). In group I (early, n = 8 patients) treatment comprised primary surgical esophageal repair in seven cases and endoscopic clipping in one case. In group II (late, n = 7 patients) treatment comprised esophagectomy without primary reconstruction (4 cases) or controlled esophagocutaneous fistula (3 cases). Measures of outcome included age (years), delay to diagnosis (h), severe sepsis on admission, mortality, and hospital and intensive care unit (ICU) stay. RESULTS The overall hospital mortality rate was 6.6% (1/15), being 0% (0/8) in group I and 14.2% (1/7) in group II. Patient age (49.6 vs. 68.6 years, P < 0.0001), delay to diagnosis (17.75 vs. 69 h, P < 0.0001), severe sepsis on admission (0 vs. 4, P = 0.0256), and ICU stay (4 vs. 14 days, P = 0.006) were all greater in group II. CONCLUSIONS Early diagnosis and carefully selected therapeutic tactics can reduce the mortality rate of Boerhaave's syndrome to an acceptably low level. Methods of organ preservation and minimally invasive techniques can be applied successfully in the treatment.
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Affiliation(s)
- György Lázár
- Department of Surgery, Albert Szent-Györgyi Medical Center, University of Szeged, Pécsi u. 6, Szeged 6720, Hungary.
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A successful strategy for surgical treatment of Boerhaave's syndrome. Surg Endosc 2011; 25:3613-9. [PMID: 21674208 DOI: 10.1007/s00464-011-1767-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Accepted: 04/18/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND This retrospective single-institution study presents a successful treatment strategy for Boerhaave's syndrome. METHODS During 1995-2008, 15 patients with spontaneous esophageal perforation were treated. Patients were grouped according to time from symptoms to referral (early, <24 h; late, >24 h). In group I (early, n = 8 patients) treatment comprised primary surgical esophageal repair in seven cases and endoscopic clipping in one case. In group II (late, n = 7 patients) treatment comprised esophagectomy without primary reconstruction (4 cases) or controlled esophagocutaneous fistula (3 cases). Measures of outcome included age (years), delay to diagnosis (h), severe sepsis on admission, mortality, and hospital and intensive care unit (ICU) stay. RESULTS The overall hospital mortality rate was 6.6% (1/15), being 0% (0/8) in group I and 14.2% (1/7) in group II. Patient age (49.6 vs. 68.6 years, P < 0.0001), delay to diagnosis (17.75 vs. 69 h, P < 0.0001), severe sepsis on admission (0 vs. 4, P = 0.0256), and ICU stay (4 vs. 14 days, P = 0.006) were all greater in group II. CONCLUSIONS Early diagnosis and carefully selected therapeutic tactics can reduce the mortality rate of Boerhaave's syndrome to an acceptably low level. Methods of organ preservation and minimally invasive techniques can be applied successfully in the treatment.
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Shabbir A, Liang S, Lomanto D, Ho KY, So JBY. Closure of gastrotomy in natural orifice transluminal endoscopic surgery: a feasibility study using an ex vivo model comparing endoloop with endoclip. Dig Endosc 2011; 23:130-4. [PMID: 21429017 DOI: 10.1111/j.1443-1661.2010.01047.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Closure of access site is one of the key issues that will determine the development of natural orifice transluminal endoscopic surgery. Our study was designed to compare the effectiveness of gastrotomy closure using endoloop and endoclip with hand-sewn closure as a control. METHODS Gastrotomy was carried out on 24 ex vivo porcine stomachs and the gastrotomies were randomized to be closed with either hand-sewn, endoloop or endoclip techniques. A 2 cm gastrotomy was created with a needle knife and sphincterotome and the defects closed thereafter. We measured the time to closure of gastrotomy and the pressure at which the closure leaked. RESULTS Three endoloops were required for all the closures in the endoloop group. In the endoclip group, the mean (range) number of endoclips used was 10 (8-13). There was no difference in the median closure times between endoloop 28 (16-58) min and endoclip 30 (21-40) min; however, time for hand-sewn closure was much shorter (3-5 min). All stomachs were successfully distended with air without leak at the end of the procedure and none experienced fluid leak. The endoclip closure endured a significantly higher median (range) pressure of 72.5 mmHg (15-80 mmHg) before leaking compared to that of an endoloop 25 mmHg (15-37 mmHg) (P < 0.001). The hand-sewn gastrotomy leaked at pressure of 95 mmHg (75-130 mmHg). The majority of air leaks were from the wound site. In the endoclip group, two leaks were noted at the clip bite site. CONCLUSION In a bench-top model, endoclips seem to be better for gastrotomy closure because of their potential to endure relatively higher pressure without any prolongation of application time. Animal survival studies are needed to explore technical and wound-closure-related problems arising as a result of use of endoclips and endoloops for gastrotomy closure.
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Affiliation(s)
- Asim Shabbir
- Department of Surgery University Surgical Centre, National University Hospital, Singapore
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Rosón Rodríguez PJ, López Ortega S, Melgarejo Cordero F, Vázquez Pedreño L, Fernández Castañer A. [Safety of conservative treatment of gastric perforation due to fish bone ingestion]. GASTROENTEROLOGIA Y HEPATOLOGIA 2009; 32:552-6. [PMID: 19647345 DOI: 10.1016/j.gastrohep.2009.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2009] [Revised: 04/23/2009] [Accepted: 05/04/2009] [Indexed: 11/24/2022]
Abstract
Intake of foreign bodies is the second most frequent indication for urgent upper gastrointestinal endoscopy. Once in the stomach, foreign bodies are usually spontaneously eliminated. However, a small percentage of large or sharp objects become stuck in the gastrointestinal mucosa. Fish bones represent a substantial number of ingested foreign bodies. We present two cases of fish bone intake producing gastric perforation satisfactorily resolved with endoscopy. Perforation is considered an absolute spcontraindication for upper and lower gastrointestinal endoscopy. Cases such as those reported herein indicate that the decision to perform endoscopic treatment should always be individualized since punctiform perforations - especially if associated with a parietal and peritoneal inflammatory reaction that helps to close the perforation spontaneously - can be treated non-surgically.
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Affiliation(s)
- Pedro J Rosón Rodríguez
- Servicio de Gastroenterología y Unidad de Endoscopia Digestiva Intervencionista, Hospital Xanit Internacional, Benalmádena, Málaga, España.
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Morgan KA, Fontenot BB, Ruddy JM, Mickey S, Adams DB. Endoscopic Retrograde Cholangiopancreatography Gut Perforations: When to Wait! When to Operate! Am Surg 2009. [DOI: 10.1177/000313480907500605] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Most perforations of the gastrointestinal tract during endoscopic retrograde cholangiopancreatography (ERCP) can be managed nonoperatively. Identifying patients who require operative management is problematic. A clinical endoscopy database was queried for patients who sustained ERCP perforation over a 13-year period. Records were reviewed and analyzed with approval of the Institutional Review Board. During the study period, 12,817 patients underwent ERCP; 24 (0.2%) had an endoscopic perforation. Twelve patients had a retroperitoneal perforation during sphincterotomy and all were successfully managed nonoperatively. Nine of these were undergoing treatment for sphincter of Oddi dysfunction. Twelve patients had perforation remote from the papilla. Of these, 10 required surgical intervention. Six patients had surgically altered anatomy (three postpancreaticoduodenectomy, three post-Billroth II gastrectomy) and one had situs inversus. Six of these seven required surgical intervention. Median length of stay of all patients was 7.5 days, morbidity was 25 per cent, and one patient died 16 days after surgery. Gut perforation after ERCP requires prompt surgical evaluation. Patients with sphincterotomy-related retroperitoneal perforation can be managed safely with nonoperative therapy in most instances. Patients with remote perforation usually need surgical intervention. Altered foregut anatomy leads to injuries that usually require operative management.
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Affiliation(s)
- Katherine A. Morgan
- Section of Gastrointestinal and Laparoscopic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Bennett B. Fontenot
- Section of Gastrointestinal and Laparoscopic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Jean M. Ruddy
- Section of Gastrointestinal and Laparoscopic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Suzanne Mickey
- Section of Gastrointestinal and Laparoscopic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - David B. Adams
- Section of Gastrointestinal and Laparoscopic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
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Abstract
Surgery has been the mainstay of therapy in patients with gastrointestinal perforations. This paradigm started to shift with the development of techniques for endoscopic closure of gastrointestinal perforations. A detailed review of the literature on this subject, along with a commentary on practical aspects in the management of patients with gastrointestinal leaks, is provided here.
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Laparoscopic approach to esophageal perforation secondary to pneumatic dilation for achalasia. Surg Endosc 2008; 23:1106-9. [PMID: 18814004 DOI: 10.1007/s00464-008-0114-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2008] [Revised: 07/05/2008] [Accepted: 07/08/2008] [Indexed: 02/06/2023]
Abstract
BACKGROUND Perforation of the esophagus after pneumatic dilation for achalasia is a severe complication which should be treated accurately in order to obtain a successful immediate outcome and a satisfactory result for the underlying condition. METHODS Five consecutive patients presenting with distal esophageal perforation after pneumatic dilation for achalasia were included in this study. All patients had gastrografin swallow performed to confirm the perforation, and one patient was also submitted to flexible esophagoscopy. Laparoscopic approach was performed in all patients with five portals. The phrenoesophageal membrane was opened on its anterior aspect. The distal esophagus was dissected free, and perforations were identified with the help of methylene blue or milk administration through the esophageal tube. All perforations were sutured with interrupted absorbable sutures. Contralateral myotomy and partial anterior Dor fundoplication completed the operation. Endoscopic control of length of myotomy and watertightness of mucosal closure was performed in all cases. RESULTS There were no intraoperative complications. After surgery all patients were maintained with nil per os until a barium swallow showed no leakage. One patient had a radiologic leakage sustained for 1 week. All patients were dismissed uneventfully. At 6 months after surgery, esophageal manometry was performed. Mean lower esophageal sphincter resting pressure had fallen from 30 to 8.7 mmHg. CONCLUSIONS Laparoscopy offers an excellent approach to treat distal esophageal instrumental perforations, perhaps even better than open surgery. Suture of the perforation, contralateral myotomy and partial anterior fundoplication is a good option in the treatment of perforated achalasia after pneumatic dilation.
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Tuebergen D, Rijcken E, Mennigen R, Hopkins AM, Senninger N, Bruewer M. Treatment of thoracic esophageal anastomotic leaks and esophageal perforations with endoluminal stents: efficacy and current limitations. J Gastrointest Surg 2008; 12:1168-76. [PMID: 18317849 DOI: 10.1007/s11605-008-0500-4] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2007] [Accepted: 02/05/2008] [Indexed: 02/06/2023]
Abstract
BACKGROUND Intra-thoracic esophageal leakage after esophageal resection or esophageal perforation is a life-threatening event. The objective of this non-randomized observational study was to evaluate the effects of endoluminal stent treatment in patients with esophageal anastomotic leakages or perforations in a single tertiary care center. METHODS Thirty-two consecutive patients with an intrathoracic esophageal leak, caused by esophagectomy (n = 19), transhiatal gastrectomy (n = 3), laparoscopic fundoplication (n = 2), and iatrogenic or spontaneous perforation (n = 8), undergoing endoscopic stent treatment were evaluated. Hospital stay, mortality and morbidity, sealing rate, extraction rates, complications, and long-term effects were measured. RESULTS Median time interval between diagnosis and stent treatment was 3 and 5 days, respectively. Eighteen patients had futile surgical closure of the defect before stenting, while in 14 patients, stent placement was the primary treatment for leakage. Stent placement was technically correct in all patients. Functional sealing was achieved in 78%. Mortality was 15.6%. Stent extraction rate was 70%. Overall method-related complications occurred in nine patients (28%). CONCLUSIONS Implantation of self-expanding stents after esophageal resection or perforation is a feasible and safe procedure with an acceptable morbidity even if used as last-choice treatment.
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Affiliation(s)
- Dirk Tuebergen
- Department of General Surgery, Unit of Surgical Endoscopy, University of Muenster, Muenster, Germany
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23
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Bhatia NL, Collins JM, Nguyen CC, Jaroszewski DE, Vikram HR, Charles JC. Esophageal perforation as a complication of esophagogastroduodenoscopy. J Hosp Med 2008; 3:256-62. [PMID: 18570335 DOI: 10.1002/jhm.289] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Fifty years ago, esophageal perforation was common after rigid upper endoscopy. The arrival of flexible endoscopic instruments and refinement in technique have decreased its incidence; however, esophageal perforation remains an important cause of morbidity and mortality. This complication merits a high index of clinical suspicion to prevent sequelae of mediastinitis and fulminant sepsis. Although the risk of perforation with esophagogastroduodenoscopy alone is only 0.03%, this risk can increase to 17% with therapeutic interventions in the setting of underlying esophageal and systemic diseases. A wide spectrum of management options exist, ranging from conservative treatment to surgical intervention. Prompt recognition and management, within 24 hours of perforation, is critical for favorable outcomes.
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Affiliation(s)
- Nisha L Bhatia
- Division of Hospital Internal Medicine, Mayo Clinic Arizona, Phoenix, Arizona, USA.
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24
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Abstract
Endoscopic clips are relatively new devices that have been shown to be effective for the control of acute gastrointestinal hemorrhage. Various different models are available and offer simplicity of use with relatively few complications. Recently, endoscopic clips have been used for a variety of non-hemorrhagic conditions. In this article we review the literature and present current thinking about the indications, efficacy and safety of these devices.
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Affiliation(s)
- Michael J Grupka
- Department of Medicine, University of Connecticut Health Center, Farmington, Connecticut, USA.
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25
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Kim JS, Kim HK, Cho YS, Chae HS, Kim CW, Kim BW, Han SW, Choi KY. Extraction and clipping repair of a chicken bone penetrating the gastric wall. World J Gastroenterol 2008; 14:1955-1957. [PMID: 18350641 PMCID: PMC2700413 DOI: 10.3748/wjg.14.1955] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2007] [Revised: 12/10/2007] [Indexed: 02/06/2023] Open
Abstract
We report a case of gastric penetration caused by accidental ingestion of a chicken bone in a 42-year old woman with a partially wearing denture. Three days ago, she accidentally swallowed several lumps of poorly-chewed chicken. Physical examination disclosed mild tenderness in the periumbilical area. Abdominal Computed tomography (CT) showed a suspicious penetration or perforation of the stomach wall measuring about 3 cm, by a linear radiopaque material at the lesser curvature of the antrum. The end of a chicken bone was very close to but did not penetrate the liver. Endoscopic examination revealed a chicken bone that penetrated into the prepyloric antrum. The penetrating chicken bone was removed with grasping forceps. Five endoscopic clips were applied immediately at the removal site and the periumbilical pain resolved promptly. After removal of the chicken bone, the patient was treated with conservative care for three days, after which she was completely asymptomatic and discharged without complication. To treat gastric penetration by a foreign body, endoclipping can be a useful method in patients with no signs or symptoms of peritoneal irritation.
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26
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Endoclipping of iatrogenic colonic perforation to avoid surgery. Surg Endosc 2007; 22:1500-4. [DOI: 10.1007/s00464-007-9682-1] [Citation(s) in RCA: 113] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2007] [Revised: 08/30/2007] [Accepted: 10/03/2007] [Indexed: 12/16/2022]
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Shin EJ, Ko CW, Magno P, Giday SA, Clarke JO, Buscaglia JM, Sedrakyan G, Jagannath SB, Kalloo AN, Kantsevoy SV. Comparative study of endoscopic clips: duration of attachment at the site of clip application. Gastrointest Endosc 2007; 66:757-61. [PMID: 17905019 DOI: 10.1016/j.gie.2007.03.1049] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2006] [Accepted: 03/05/2007] [Indexed: 02/08/2023]
Abstract
BACKGROUND Several designs of endoscopic clips are now commercially available, and the indications for endoclip application are rapidly expanding. However, very limited data have been published to aid in choosing between the different types of endoclips. OBJECTIVE To compare the duration of clip attachment between all commercially available endoclips. SETTING Long-term experiments on 50-kg pigs under general anesthesia. DESIGN AND INTERVENTIONS Upper endoscope was inserted into the stomach. One clip of each type (Resolution clip, TriClip, and HX-5L clip) was placed along the same gastric fold at a distance of 0.5 to 1 cm from each other. The animals were recovered. In pig nos. 1 and 2, repeat endoscopy was performed after 2 and 4 weeks. In pig nos. 3 to 5, endoscopy was repeated after 1, 2, and 5 weeks. MAIN OUTCOME MEASUREMENTS Duration of clip retention at the site of application. RESULTS In all animals, only the Resolution endoclip remained attached to the site of application for the entire duration of the study (4-5 weeks). No TriClips or HX-5L clips were attached at the 4- to 5-week follow-up endoscopies. Most of the TriClips (67%) detached within the first week after application. Most of the HX-5L clips (80%) dislodged within the first 2 weeks of follow-up. LIMITATIONS The study was performed in a porcine model with a small number of animals. CONCLUSIONS The Resolution clip has the longest duration of retention at the site of application (more than 4-5 weeks) and should be preferred when long-term attachment of endoclips is necessary.
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Affiliation(s)
- Eun Ji Shin
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
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29
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Fischer A, Schrag HJ, Goos M, von Dobschuetz E, Hopt UT. Nonoperative treatment of four esophageal perforations with hemostatic clips. Dis Esophagus 2007; 20:444-8. [PMID: 17760660 DOI: 10.1111/j.1442-2050.2007.00652.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Spontaneous or iatrogenic esophageal perforations are despite advances of modern surgery and intensive care medicine still potentially life-threatening events with a considerable mortality rate. Recently, encouraging results on the sealing of esophageal perforations by placement of endoluminal prostheses were reported. However, if the perforation is very proximal (close to the larynx) or very distal (involving the cardia), the situation is to our experience unsuitable for stent therapy. In these special cases non-operative treatment is still possible by application of hemostatic metal clips. We present four cases unsuitable for stent therapy where the perforation was sealed by endoscopic clip application. All patients had an uneventful recovery. Non-operative treatment of esophageal perforations with hemostatic metal clips is feasible and safe in cases not treatable with self-expanding metal stents.
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Affiliation(s)
- A Fischer
- Department of General and Visceral Surgery, Albert-Ludwigs University of Freiburg, Germany.
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30
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Qadeer MA, Dumot JA, Vargo JJ, Lopez AR, Rice TW. Endoscopic clips for closing esophageal perforations: case report and pooled analysis. Gastrointest Endosc 2007; 66:605-11. [PMID: 17725956 DOI: 10.1016/j.gie.2007.03.1028] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2007] [Accepted: 03/19/2007] [Indexed: 02/08/2023]
Abstract
BACKGROUND Acute and chronic esophageal perforations have traditionally been treated with surgery or a conservative approach. Recently, endoscopic repair has been reported in some case reports. OBJECTIVE To describe a case of a chronic esophagoperitoneal fistula successfully closed by endoscopic clips after several failed reoperations and stent placement. To perform a pooled analysis of the reports describing such closures. DESIGN Case report and pooled analysis. SETTING Tertiary-care hospitals. PATIENTS Our patient presented with mature perforation in the distal esophagus caused by laparoscopic band gastroplasty. Patients for pooled analysis identified by a MEDLINE search (1966 to January 2007) performed for all the English language articles that reported esophageal perforation/fistulae and endoscopic clips. INTERVENTIONS Endoscopic clip application after ablation of epithelialized edges in our patient. Pooled analyses for demographic and perforation variables, along with predictors for closure time after clipping, were performed. MAIN OUTCOME MEASUREMENTS Closure of esophageal perforations. RESULTS The fistula in our patient closed in 3 weeks after endoscopic clipping. The literature review identified a total of 11 articles that describe 17 patients (acute 7, intermediate 4, and chronic 6). The most common cause was iatrogenic (65%), and the size of the perforation ranged from 3 to 25 mm. The median healing time after clipping was 18 days (interquartile range 6-26). Both univariable and multivariable analyses identified only the duration of perforation as a significant predictor of closure time, P values .003 and .02, respectively. LIMITATIONS Small sample size, nonrandomized sample. CONCLUSIONS Endoclips may be effective for closing both acute and chronic esophageal perforations. The duration of the perforation is a significant factor for predicting closure time.
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Affiliation(s)
- Mohammed A Qadeer
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio 44195, USA
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31
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Gerke H, Crowe GC, Iannettoni MD. Endoscopic closure of cervical esophageal perforation caused by traumatic insertion of a mucosectomy cap. Ann Thorac Surg 2007; 84:296-8. [PMID: 17588444 DOI: 10.1016/j.athoracsur.2007.02.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2007] [Revised: 01/28/2007] [Accepted: 02/12/2007] [Indexed: 12/15/2022]
Abstract
Cap-assisted endoscopic mucosal resection enables nonsurgical removal of superficial esophageal lesions. Perforation at the resection site is a rare but known complication of this technique. We report a case in which traumatic insertion of the mucosectomy cap led to perforation of the cervical esophagus. This complication has not been previously reported. The perforation was successfully closed by the endoscopic placement of clips.
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Affiliation(s)
- Henning Gerke
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, JCP 4548, Iowa City, IA 52242, USA.
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32
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Abstract
Endoscopic closure of gastrointestinal perforations, fistulas, and anastomotic dehiscence is technically feasible. Endoluminal closure of the instrumental perforations of the gastrointestinal tract can be accomplished immediately after the recognition of perforation, while avoiding the delay of arranging surgery and the trauma associated with thoracotomy or laparotomy. In addition, endoscopic closure should be considered in patients with anastomotic dehiscence and chronic fistulas as this may avoid the risk associated with reoperation. The outcome of closure depends on the technical expertise in the proper selection and use of various endoluminal closure options. Training of the endoscopists in the use of this novel technology will enhance the quality of care of our patients.
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Affiliation(s)
- G S Raju
- Center for Endoscopic Research, Training, and Innovation (CERTAIN), Department of Internal Medicine, 4.106 McCullough Building, 301 University Boulevard, University of Texas Medical Branch, Galveston, TX 77555-0764, USA.
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Pereira-Graterol F, Moreno-Portillo M. Distal Esophageal Perforation Repair During Laparoscopic Esophagomyotomy: Evaluation of Outcomes and Review of Surgical Technique. J Laparoendosc Adv Surg Tech A 2006; 16:587-92. [PMID: 17243875 DOI: 10.1089/lap.2006.16.587] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To describe the technique employed and our experience with primary laparoscopic repair of distal esophageal perforations produced during laparoscopic esophagomyotomy, as well as to evaluate the outcomes. MATERIALS AND METHODS We analyzed six cases of patients with primary achalasia in whom distal esophageal mucosal perforations were caused during laparoscopic esophagomyotomy. A primary repair and fundoplication was performed in five cases; in the sixth patient, the perforation could not be recognized during the surgical procedure. The postoperative follow-up included clinical evaluation, upper gastrointestinal endoscopy, esophageal manometry, and ambulatory 24-h esophageal pH monitoring. RESULTS Five patients reported dysphagia relief and were highly satisfied with the final surgical outcome. In one case we observed an altered postoperative 24-h esophageal pH. Two patients developed esophageal leakage, one with a fatal outcome. CONCLUSION The primary repair of distal esophageal perforations during laparoscopic esophagomyotomy is a valid therapeutic option and does not alter the surgical purpose. However, if the perforation is not recognized early on, the prognosis can change.
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Chuttani R, Barkun A, Carpenter S, Chotiprasidhi P, Ginsberg GG, Hussain N, Liu J, Silverman W, Taitelbaum G, Petersen B. Endoscopic clip application devices. Gastrointest Endosc 2006; 63:746-50. [PMID: 16650531 DOI: 10.1016/j.gie.2006.02.042] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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35
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Raju GS, Pham B, Xiao SY, Brining D, Ahmed I. A pilot study of endoscopic closure of colonic perforations with endoclips in a swine model. Gastrointest Endosc 2005; 62:791-5. [PMID: 16246701 DOI: 10.1016/j.gie.2005.07.047] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2005] [Accepted: 07/28/2005] [Indexed: 12/10/2022]
Abstract
BACKGROUND Surgical closure of a colon perforation is accompanied by the risks of general anesthesia and prolonged recovery from surgery because of ileus and other sequelae. Very little is known about the effectiveness of endoluminal repair of colon perforations with clips, which eliminates incisions of the abdominal wall and provides a less invasive alternative to surgical closure. The aim of this study is to evaluate the feasibility and the safety of endoscopic closure of colonic perforations with endoclips in a porcine model. METHODS Approximately 1.5- to 2-cm colon perforations created with a needle knife in 4 50-kg, female pigs that were under general anesthesia were closed with endoclips. After 24 hours of recovery, the animals were allowed to eat. All the animals received intravenous antibiotics and were carefully monitored for signs of sepsis. After a follow-up of 1 week, the pigs were euthanized for postmortem examination. The fifth pig was euthanized immediately after closure of a 5-cm colon perforation with clips to evaluate the extent of transmural closure with endoclips. RESULTS The animals recovered well, without any clinical features of sepsis or peritonitis. Postmortem examination did not reveal fecal peritonitis, and there was no evidence of pericolonic abscess formation at the site of perforation. The perforation site showed signs of healing without any evidence of transmural dehiscence. Histopathology demonstrated granulation tissue bridging the site of perforation. In the fifth pig, euthanized immediately after closure of the perforation, nice mucosal apposition was seen, while the muscular and serosal coats remained dehisced. CONCLUSIONS Endoscopic closure of small iatrogenic colon perforations with clips results in mucosal and submucosal healing and prevents fecal soiling of peritoneal cavity.
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Affiliation(s)
- Gottumukkala S Raju
- Center for Endoscopic Research, Training, and Innovation (CERTAIN), Department of Medicine, Surgery and Pathology, University of Texas Medical Branch, Galveston, Texas 77555-0764, USA
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37
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Katsinelos P, Paroutoglou G, Papaziogas B, Beltsis A, Dimiropoulos S, Atmatzidis K. Treatment of a duodenal perforation secondary to an endoscopic sphincterotomy with clips. World J Gastroenterol 2005; 11:6232-4. [PMID: 16273659 PMCID: PMC4436649 DOI: 10.3748/wjg.v11.i39.6232] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Perforation is one of the most serious complications of endoscopic sphincterotomy (ES) necessitating immediate surgical intervention. We present a case of successful management of such a complication with endoclipping. A 85-year-old woman developed duodenal perforation after ES. The perforation was identified early and its closure was achieved using three metallic clips in a single session. There was no procedure-related morbidity or complications and our patient was discharged from hospital 10 d later. Endoclipping of duodenal perforation induced by ES is a safe, effective and alternative to surgery treatment.
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Affiliation(s)
- Panagiotis Katsinelos
- Department of Endoscopy and Motility Unit, "G.Gennimatas" Hospital, Ethnikis Aminis 41, 54635 Thessaloniki, Greece.
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38
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Teitelbaum JE, Gorcey SA, Fox VL. Combined endoscopic cautery and clip closure of chronic gastrocutaneous fistulas. Gastrointest Endosc 2005; 62:432-5. [PMID: 16111964 DOI: 10.1016/j.gie.2005.04.047] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2005] [Accepted: 04/28/2005] [Indexed: 02/08/2023]
Abstract
BACKGROUND Chronic gastrocutaneous fistula with intermittent drainage is a common outcome after removing long-standing gastrostomy tubes. The standard treatment is surgery with laparotomy and excision of the fistula tract. This study describes the results of an endoscopic closure technique by using a combination of electrocautery and metal clips. METHODS Three patients with gastrocutaneous fistulas (duration 3 months to 3 years) after gastrostomy tube removal were treated endoscopically by electrocautery of the tract and application of metal clips. OBSERVATIONS Treatment resulted in complete fistula closure in two patients and partial closure in a third patient. CONCLUSIONS Combined endoscopic therapy with electrocautery and clipping may be an alternative to surgical closure of chronic gastrocutaneous fistulas.
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Affiliation(s)
- Jonathan E Teitelbaum
- Department of Pediatric Gastroenterology and Nutrition, Monmouth Medical Center, Long Branch, New Jersey, USA
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39
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Raju GS, Thompson C, Zwischenberger JB. Emerging endoscopic options in the management of esophageal leaks (videos). Gastrointest Endosc 2005; 62:278-86. [PMID: 16046996 DOI: 10.1016/s0016-5107(05)01632-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Gottumukkala S Raju
- Division of Gasterology and Thoraic Surgery, Center for Endoscopic Research, Education, and Training (CERTAIN), University of Texas Medical Branch, Galveston, 77555, USA
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40
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Katsinelos P, Beltsis A, Paroutoglou G, Galanis I, Tsolkas P, Mimidis K, Pilpilidis I, Baltagiannis S, Kamberis E, Papaziogas B. Endoclipping for Gastric Perforation After Endoscopic Polypectomy: An Alternative Treatment to Avoid Surgery. Surg Laparosc Endosc Percutan Tech 2004; 14:279-81. [PMID: 15492658 DOI: 10.1097/00129689-200410000-00010] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 47-year-old woman underwent endoscopic polypectomy of a villous adenoma in the lesser curvature of the gastric antrum. Shortly after the procedure, she complained of severe abdominal pain. An abdominal x-ray showed air under the diaphragm, suggestive of gastric perforation. On re-endoscopy, the cavity at the site of polypectomy was closed using endoscopically applied metallic clips. She was treated with intravenous hyperalimentation, omeprazole, and antibiotics for 10 days. Ingestion of food was started 10 days after admission, and she was discharged without any complaints. She is free of symptoms on follow-up after 8 months, and endoscopy showed complete healing of the perforation. The procedure is the third described for the stomach in the English literature and emphasizes the use of endoclipping in selected cases of small and well-defined perforations.
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41
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Shimizu Y, Kato M, Yamamoto J, Nakagawa S, Komatsu Y, Tsukagoshi H, Fujita M, Hosokawa M, Asaka M. Endoscopic clip application for closure of esophageal perforations caused by EMR. Gastrointest Endosc 2004; 60:636-9. [PMID: 15472698 DOI: 10.1016/s0016-5107(04)01960-1] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND With increasing use of EMR for early stage esophageal carcinoma, the number of cases of iatrogenic esophageal perforation is likely to increase. This study evaluated the results of endoscopic clip application for treatment of perforations caused by EMR in patients with esophageal carcinoma. METHODS Among 185 patients who underwent EMR for esophageal carcinoma, esophageal perforation occurred in 3 patients (1.6%). Metallic clips were immediately applied endoscopically to close the perforations. OBSERVATIONS All 3 patients were observed closely and were managed conservatively (intravenous hyperalimentation, antibiotics) after closure of the perforation. They were discharged without any further serious complication. CONCLUSIONS When esophageal perforation caused by EMR is immediately recognized, endoscopic application of metallic clips is appropriate therapy. However, patients must be carefully monitored for the development of generalized mediastinitis.
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Affiliation(s)
- Yuichi Shimizu
- Third Department of Internal Medicine, Hokkaido University School of Medicine, Sapporo, Japan
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42
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Zanati SA, Ganc RL, Kortan P. Endoscopic modification of a Billroth II gastrojejunostomy by using metallic clips. Gastrointest Endosc 2004; 60:485-8. [PMID: 15332055 DOI: 10.1016/s0016-5107(04)01817-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Simon A Zanati
- The Centre for Therapeutic Endoscopy and Endoscopic Oncology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada M5B 1W8
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43
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Charabaty-Pishvaian A, Al-Kawas F. Endoscopic treatment of duodenal perforation using a clipping device: case report and review of the literature. South Med J 2004; 97:190-3. [PMID: 14982273 DOI: 10.1097/01.smj.0000091031.77846.b6] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The standard treatment for gastrointestinal perforation secondary to an endoscopic procedure is surgical repair. Some authors advocate a conservative medical management. However, this approach may be associated with increased morbidity and mortality. We describe a case of duodenal perforation secondary to snare polypectomy that was successfully treated with endoclipping. Additional published case reports were reviewed. Current data suggest that endoclipping may be appropriate in the management of a select group of patients with iatrogenic gastrointestinal perforation.
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44
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Affiliation(s)
- Gottumukkala S Raju
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas 77555-0764, USA
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45
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Familiari P, Macrì A, Consolo P, Angiò L, Scaffidi MG, Famulari C, Familiari L. Endoscopic clipping of a colocutaneous fistula following necrotizing pancreatitis: case report. Dig Liver Dis 2003; 35:907-910. [PMID: 14703889 DOI: 10.1016/j.dld.2003.05.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The case described here is of a 73-year-old male patient who developed a colocutaneous fistula following necrotizing pancreatitis, diagnosed by imaging and treated endoscopically by the application of an endoclip. Pancreatic and gastrointestinal fistulas, common complications of surgery for necrotizing pancreatitis, frequently require surgical treatment. Colonic perforations are the most difficult to treat surgically on account of the risk of peritonitis. A technique, namely, endoscopic clips application, has recently been developed to close anastomotic leakages and perforations of the oesophagus, stomach and colon. In the patient described here, endoscopic repair was technically easy and the good result was confirmed within a few days. In order to repair colonic fistulas following pancreatitis, application of endoclips could, in our opinion, provide a useful therapeutic option, feasible in selected patients.
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Affiliation(s)
- P Familiari
- Emergency Surgery Unit, University of Messina, Messina, Italy.
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46
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Mizobuchi S, Kuge K, Maeda H, Matsumoto Y, Yamamoto M, Sasaguri S. Endoscopic clip application for closure of an esophagomediastinal-tracheal fistula after surgery for esophageal cancer. Gastrointest Endosc 2003; 57:962-5. [PMID: 12776057 DOI: 10.1016/s0016-5107(03)70054-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Shunji Mizobuchi
- Department of Surgery II, Kochi Medical School, Kohasu, Okohcho, Nankoku, Japan
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Tsunada S, Ogata S, Ohyama T, Ootani H, Oda K, Kikkawa A, Ootani A, Sakata H, Iwakiri R, Fujimoto K. Endoscopic closure of perforations caused by EMR in the stomach by application of metallic clips. Gastrointest Endosc 2003; 57:948-51. [PMID: 12776053 DOI: 10.1016/s0016-5107(03)70051-0] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The number of complications associated with use of EMR for early-stage gastric cancer, including perforation, has increased with the increasing use of this procedure. Endoscopic clip application was performed in patients who sustained a perforation as a result of EMR for gastric neoplasm. PATIENTS AND METHODS Seven patients who underwent endoscopic application of metallic clips to close perforations were studied. The omental patch method was applied in one case with a large perforation. OBSERVATIONS In all patients, endoscopic clip application successfully closed the perforation of the stomach, which occurred after EMR. No patient required laparotomy. CONCLUSIONS The technique of endoscopic clip application might be useful for treatment of patients who sustain a perforation caused by EMR.
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Affiliation(s)
- Seiji Tsunada
- Department of Internal Medicine and Endoscopy, Saga Medical School, Saga, Japan
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Katsetos MC, Tagbo AC, Lindberg MP, Rosson RS. Esophageal perforation and mediastinitis from fish bone ingestion. South Med J 2003; 96:516-20. [PMID: 12911196 DOI: 10.1097/01.smj.0000047744.34423.0b] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Esophageal perforation is a serious condition with a high mortality rate. Successful therapy depends on the size of the rupture, the time elapsed between rupture and diagnosis, and the underlying health of the patient. Common causes of esophageal perforation include medical instrumentation, foreign-body ingestion, and trauma. A case of esophageal perforation due to fish bone ingestion in a 70-year-old diabetic male is described here, with a review of the pertinent literature. The patient presented with odynophagia after a meal that included fish. Initial evaluation was nondiagnostic and the patient was discharged home. The patient returned 12 days later with fever, generalized weakness, and persistent dysphagia. Esophageal biopsy of a necrotic ulcer revealed foreign material with acute inflammatory changes. Computed tomography scan demonstrated a pneumomediastinum. The patient became hemodynamically unstable and died on the third hospital day.
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Affiliation(s)
- Manny C Katsetos
- Internal Medicine Residency Program, and Hartford Hospital, University of Connecticut School of Medicine, Hartford, CT 06102-5037, USA.
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Raymer GS, Sadana A, Campbell DB, Rowe WA. Endoscopic clip application as an adjunct to closure of mature esophageal perforation with fistulae. Clin Gastroenterol Hepatol 2003; 1:44-50. [PMID: 15017516 DOI: 10.1053/jcgh.2003.50007] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Esophageal perforation is associated with high morbidity and mortality. Surgery and drainage are considered primary management. Conservative management is an option in a select group. Conservative treatment requires drainage, control of infection, nutritional support, and considerable patience. METHODS We describe 3 cases in which endoscopic metallic clips were placed to close mature perforations with associated fistulae. All 3 patients underwent mucosal approximation of the defects under direct endoscopic visualization. RESULTS A review of the literature revealed only 4 other reports of the use of endoclipping for esophageal perforation, one diagnosed immediately, a second within 24 hours, a third diagnosed after 2 days and endoclipped after prolonged mediastinal drainage, and a fourth believed to be chronic. The cases presented here represent well-established, mature defects. CONCLUSIONS Endoscopic treatment of mature esophageal perforation with metallic clips can be performed to promote closure. In combination with other conservative medical efforts, this method can be used safely and effectively for selected patients.
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Affiliation(s)
- Geoffrey S Raymer
- Division of Gastroenterology and Hepatology, Pennsylvania State University, Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
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Affiliation(s)
- B C Jacobson
- Department of Medicine, and the Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA
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