Loop-Clip closure of acute iatrogenic perforations-A tertiary care centre experience

Aims The study aims at studying the effectiveness of Loop-clip method by a single channel endoscope in closure of acute iatrogenic perforations.

Methods a predetached endoloop (LeClamp ligation device; Leo Medical Co Ltd, Changzhou, China) fixed to the hemoclip (Resolution clip, Boston Scientific, Boston, Mass, USA) was delivered using a single-channel endoscope (GIF-HQ190 Olympus, Tokyo, Japan) and anchored near the proximal margin of the defect, followed by deployment of consecutive hemoclips to anchor the endoloop along the margins of the defect. The endoloop was then tightened slowly by reattaching it to a hooking device (endoloop delivery system) resulting in approximation of the borders of the perforation and closing it in a purse-string fashion

Results A total of 24 cases of iatrogenic perforations were closed using the loop-clip method at our institution (the biggest endoscopic centre in country). The site of perforations was 1 oesophageal, 6 Gastric, 3 duodenal, 1 jejunal and 13 colonic. 19 patients had perforations during therapeutic procedures (Oesophageal dilatation, Gastric ESD, SEMS deployment of a jejunal anastomotic leak, Colonic EMR/ESD). To the best of our knowledge, endoscopic closure of a jejunal perforation in altered anatomy using loop and clips has not been described in the literature.The mean size of the defect was 2.1 cms. The mean closure time was 12.7 minutes. 23(95%) of the patients complained of abdominal pain, 16(67%) patients developed fever mostly on day 2 of admission which settled with iv antibiotics. All the defects (100%) were closed successfully. None required surgery.

Conclusions We found Loop-Clip method aN effective method for closure of largiatrogenic perforations.

 

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Conflicts of interest

Authors do not have any conflict of interest to disclose.

Publikationsverlauf

Artikel online veröffentlicht:
14. April 2023