Efficiency and safety of the OTS-Clip Padlock clip in the management of iatrogenic colonic perforations: A RETROSPECTIVE MONOCENTRIC STUDY over 4years

Aims OTS-clips have been a breakthrough in the management of iatrogenic colonic perforations during colonoscopy. In France, the OVESCO clip, distributed by OVESCO Endoscopy, has been available since 2010, while the PADLOCK clip, distributed by Duomed, has been available since 2018. The OVESCO clip has been widely studied, demonstrating safety and efficacy comparable to surgical sutures. However, there is less data on the PADLOCK clip. This retrospective study aims to evaluate the safety and efficacy of the OTS-clip PADLOCK clip in managing iatrogenic colonic perforations since its introduction in 2019.

Methods This study included all iatrogenic colonic perforations treated with a PADLOCK clip between 2019 and 2023, involving 20 patients (13 females and 7 males) with an average age of 62.5 years. All perforations were classified as Type IV according to the Sidney classification, indicating muscular layer rupture. Nineteen perforations occurred during endoscopic resection (18 submucosal dissections and 1 mucosectomy), with one occurring during diagnostic colonoscopy. Data collected included perforation site, size, feasibility of endoscopic repair, need for additional treatment, CT scan results, clinical success, complications, mortality, and stoma creation [1] [2] [3] [4] [5] [6] [7].

Results All iatrogenic colonic perforations treated with a PADLOCK clip between 2019 and 2023 were included, representing 20 patients (13 females and 7 males) with an average age of 62.5 years (+ /- 19.5 years). All perforations corresponded to Type IV in the Sidney classification, indicating a rupture of the muscular layer. Nineteen perforations occurred following endoscopic resection (18 submucosal dissections and 1 mucosectomy), and one was a direct perforation during diagnostic colonoscopy progression. The following information was collected: site of perforation, size of perforation, feasibility of endoscopic repair, need for immediate additional treatment (endoscopic or surgical), use of ancillary equipment, early CT scan results after closure, clinical success defined by the absence of surgery, complications related to OTS-clip Padlock clip placement, mortality related to perforation, and stoma creation.

Conclusions This series, the largest in the literature to our knowledge concerning the safety and efficacy profile of using the OTS-clip Padlock clip for endoscopic repair of iatrogenic colonic perforations, demonstrates excellent efficacy and absence of morbidity of this material in the endoscopic management of iatrogenic perforations during colonoscopy, with efficacy comparable to that of OVESCOOTSCclips.

 

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Conflicts of interest

No conflicts of interest

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Publication History

Article published online:
27 March 2025