Endoscopic clips for the closure of acute iatrogenic perforations: Where do we stand?

Yılmaz, Bülent; Ünlü, Ozan; Roach, Emir Charles; Can, Güray; Efe, Cumali; Korkmaz, Uğur; Kurt, Mevlüt

doi:10.1111/den.12482

Cited by 43 publications

(37 citation statements)

References 65 publications

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“…From treating gastrointestinal bleeding to perforations, endoscopic clips have an increasingly important role. Conventional endoscopic clips, also known as through-the scope clips (TTSC), can effectively close perforations of the esophagus, stomach, duodenum and colon[5,6,9,19,30-32]. There was no failure in three patients with esophageal perforations following EMR managed by endoclips, as reported by Shimizu et al[5].…”

Section: New Devices and Techniquesmentioning

confidence: 75%

“…Among these etiologies, iatrogenic factors contribute most to the increased incidence of perforations. These iatrogenic factors include endoscopic examination, endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), peroral endoscopic myotomy, endoscopic retrograde cholangiopancreatography (ERCP), stricture dilation, foreign body removal and malignant tumors[2,5-9]. The incidence of iatrogenic perforations varies in diagnostic and therapeutic endoscopy, ranging from 0.029% to 5%[10,11].…”

Section: Introductionmentioning

confidence: 99%

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New devices and techniques for endoscopic closure of gastrointestinal perforations

Meng

et al. 2016

WJG

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Gastrointestinal perforations, which need to be managed quickly, are associated with high morbidity and mortality. Treatments used to close these perforations range from surgery to endoscopic therapy. Nowadays, with the development of new devices and techniques, endoscopic therapy is becoming more popular. However, there are different indications and clinical efficacies between different methods, because of the diverse properties of endoscopic devices and techniques. Successful management also depends on other factors, such as the precise location of the perforation, its size and the length of time between the occurrence and diagnosis. In this study, we performed a comprehensive review of various devices and introduced the different techniques that are considered effective to treat gastrointestinal perforations. In addition, we focused on the different methods used to achieve successful closure, based on the literature and our clinical experiences.

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Section: New Devices and Techniquesmentioning

confidence: 75%

Section: Introductionmentioning

confidence: 99%

New devices and techniques for endoscopic closure of gastrointestinal perforations

Meng

et al. 2016

WJG

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“…Although we concur with Kantsevoy et al 4 that endoscopic full-thickness suturing provides a more robust closure than TTS clip placement, the latter has been shown to be effective for small (subcentimeter) iatrogenic perforations that are recognized and closed immediately at the time of the procedure. 5,6 In both studies, the mean perforation size was approximately 5 mm, and the suboptimal outcomes in the clip group of the Kantsevoy et al 4 study are the exception rather than the rule in comparison with published data. Ultimately, determination of the optimal technique for iatrogenic perforation closure in the colon would require prospective comparative assessment of TTS clip placement versus endoscopic suturing, although we realize that such a study may be difficult to perform given the relatively uncommon occurrence of this adverse event.…”

mentioning

confidence: 76%

Closing the lid on iatrogenic colonic perforations

Law

Song

2016

Gastrointestinal Endoscopy

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“…D). Flexible endoscopy can result in iatrogenic cervical esophageal and gastrointestinal perforation . When the pressure applied to the mucous membrane of the large intestines exceeds 2–3 kg/cm 2 , the large intestine can perforate .…”

Section: Brief Explanationmentioning

confidence: 99%

Development of a novel humanoid‐robot simulator for endoscope with pharyngeal reflex and real‐life responses

Ueki

Uehara

Isomoto

2018

Digestive Endoscopy

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In recent years, there has been a growing need for skills quantification of endoscopic specialists. Various educational simulators have been created to help increase the endoscopy performance of medical students and trainees. Recent research seems to show that the use of simulators helps increase the skill level of endoscopists, while improving patient safety. 1,2 However, previous simulators lack sufficient realism and are unable to replicate natural human reactions during endoscopy or quantify endoscopic skills. We developed a novel humanoidrobot simulator (named mikoto â ) with pharyngeal reflexes and real-life responses to endoscopy. This humanoid robot has pressure sensors in its pharynx. Sensitivity of the silicon-plated Figure 1 Touch sensor quality of the robot "mikoto". Pressure of the sensor is nearly identical to the "gold standard" of a force gauge (RZ-20; Aikoh Engineering Co. Ltd, Osaka, Japan). (a) 0-50 Newton (N) pressure was applied to an 8-mm pusher to the point where it caused the porcine oral mucous membrane to intervene on the mikoto pressure sensor. (b) 0-50 N pressure was applied to an 8-mm pusher to the state where it caused the silicone rubber membrane to intervene on the mikoto pressure sensor. (c) Output of the mikoto sensor, when the porcine oral mucous membrane intervened on the mikoto pressure sensor, is indicated in red. The output where the silicone rubber membrane intervened on the mikoto pressure sensor is indicated in blue. The vertical axis is the output of the mikoto sensor and the transverse axis is the force gauge. Even if the silicone rubber or the porcine oral mucous membrane intervened, performance of the touch sensor was maintained.

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Endoscopic clips for the closure of acute iatrogenic perforations: Where do we stand?

Abstract: There is strong evidence to show the efficacy of endoclips in the management of iatrogenic perforations, especially when recognized early. Limitations of endoclipping such as inefficiency against large perforations may be overcome by improving novel techniques in the future.

Cited by 43 publications

References 65 publications

New devices and techniques for endoscopic closure of gastrointestinal perforations

New devices and techniques for endoscopic closure of gastrointestinal perforations

Closing the lid on iatrogenic colonic perforations

Development of a novel humanoid‐robot simulator for endoscope with pharyngeal reflex and real‐life responses

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