A novel system for endoscopic closure of iatrogenic colon perforations using the Ovesco® clip and omental patch

Abstract

The growing endoscopic activity, both diagnostic and therapeutic, are also globally makes frequent endoscopic complications, perforation being one of the most serious. However, we also have more possibilities for endoscopic resolution of iatrogenic caused. We report the case of a sigmoid perforation during a colonoscopy that was resolved satisfactorily, avoiding surgery, by endoscopic closure with a nitinol clip Ovesco ® . CASE REPORTAn 82-year-old woman was admitted for assessment of iron deficiency after an episode of syncope. She had a surgical history of hiatal hernia repair 20 years earlier (which subsequently relapsed) and hysterectomy. Tumour markers were normal. Gastroscopy confirmed the presence of a hiatal hernia. Colonoscopy under deep sedation with propofol only and CO 2 insufflation revealed no abnormalities in the explored colonic segment. After traversing about 25 cm of the fixed sigmoid colon with difficulty, an iatrogenic perforation occurred. The perforation was immediately noticed and the endoscope was withdrawn, revealing an approximately 12 mm hole 18 cm distal to the anal margin, through which omentum could be seen (Fig. 1) CLINICAL NOTEDíez-Redondo P, Blanco JI, Lorenzo-Pelayo S, de la SernaHiguera C, Gil-Simón P, Alcaide-Suárez N, Pérez-Miranda M. A novel system for endoscopic closure of iatrogenic colon perforations using the Ovesco® clip and omental patch. Rev Esp Enferm Dig 2012;104:550-552. Fig. 1. Endoscopic image of colonic wall perforation, through which an epiploic appendix is visible.

Endoscopic clip closure of gastrointestinal perforations, fistulae, and leaks

“…A recent review on clip closure of colonoscopic perforations summarized the developments in the field over the last decade . TTSC, OTSC and, in some cases, a combination of both clips have been used to close perforations, with or without an omental patch . Initial experience on endoscopic closure of large perforations occurring during diagnostic colonoscopy is encouraging …”

“…Recently, the OTSC device has been shown to be successful in the closure of larger perforations (<30 mm) of the colon and rectum . In some cases, combination of an omental patch closure technique with deployment of the OTSC and TTSC devices may be required for successful closure …”

Endoscopic band ligation for closure of GI perforations in a porcine animal model (with video)

“…14 Endoscopic closure by using this technique with TTS clips, EBL, and the OTSC has been described. 3,15,16 Based on our experimental data and available medical literature, EBL and OTS clips allow omental fat to be suctioned into the lumen and incorporated into the closure. For the 3 cases in which omentum was used for closure, the omental plug was present within the luminal defect on entry into the peritoneal cavity; however, during specimen resection, the omental plug was minimally adherent to the luminal tissue.…”

“…By using electrocautery, a needle-knife (Cook Endoscopy, Winston-Salem, NC) was used to create a single, free-hand, linear perforation to allow passage of a balloon dilator. Balloon dilation was performed to ensure accurate perforation size (10,15, and 20 mm) after incision (Fig. 1A).…”

An ‘omental patch’ created during over-the-scope clipping completely sealed a duodenal perforation after endoultrasonography

“…As shown in a few reports in the literature [Donatelli et al 2013;Meduri et al 2014;Díez-Redondo et al 2012], given the high rate of morbidity and mortality associated with post-surgical treatment of iatrogenic duodenal perforations, the OTSC should be considered the first option for immediate resolution of this adverse event, taking into account the possible risk of failure.…”