Endoscopic Clipping of Esophageal Perforation After Pneumatic Dilation for Achalasia

Abstract

A 67-year-old man with a long history of achalasia underwent pneumatic dilation of the lower esophageal sphincter due to increasing dysphagia. During the procedure, a small perforation of the thoracic part of the distal esophagus occurred. Since the rupture was small, well-confined, and detected immediately, the lesion was closed using endoscopically applied metallic clips. The patient did very well, and a contrast swallow three days later showed no leakage of the esophagus. This procedure has not yet been described for the esophagus in the literature, but it may be considered in selected cases of small and well-defined instrumental perforations.

Enterocutaneous Fistula From A Billroth II Afferent Limb: Successful Closure With Endoclips

“…4 In 2003, Familiari et al described endoclip closure of a colocutaneous fistula, which occurred following an episode of necrotizing pancreatitis. 5 Gastrocutaneous fistula, which occasionally occurs after removal of a percutaneous gastrostomy tube, also lends itself to endoclip closure.…”

“…Recent case reports describe more expanded utility to include closure of gastrocutaneous fistulae and viscus perforations. [4][5][6][7] The ability to treat such breaches in intestinal continuity endoscopically and avoid surgery has great potential for shortening hospital stays and decreasing patient morbidity and mortality. We report a patient with prior Billroth II surgery who developed a duodeno-cutaneous fistula following laparotomy to resect a hepatic flexure colon mass.…”

Endoscopic closure of iatrogenic perforation

“…The causes of perforation were; removal of food impaction, 37 cap mucosectomy, 38 dilatation of achalasia 39 or esophageal anastomotic stricture, 40 EMR, 41 and ESD. 42 The range of perforation length was 7 to 40 mm, the majority of location was distal esophagus (72%), and the healing time after clipping was 3 to 13 days.…”

“…42 The range of perforation length was 7 to 40 mm, the majority of location was distal esophagus (72%), and the healing time after clipping was 3 to 13 days. [37][38][39][40][41][42][43] All but one patient achieved complete mucosal healing in one session, that such patient required two sessions of endoscopic closure to achieve healing. 37 To enhance the visualization of defect while closing, a transparent cap may be used.…”

“…52,53 In a prospective multicenter study included 5 iatrogenic esophageal perforations, OTSC provided 100% success rate of closure. 39 Although it is a very rare event, additional esophageal perforation caused by the OTSC cap itself has been reported with the incidence of 0.03%. 53 Endoscopic band ligation (EBL) is usually used for esophageal variceal ligation.…”