Endoscopic Closure of Duodenal Perforation with the Over-the-scope-clipping System

Abstract

Endoscopic treatment for superficial non-ampullary duodenal tumors is technically difficult and challenging due to the anatomical characteristics of the duodenum. It is frequently complicated by procedural accidents, such as perforation. Surgical repair has long been the standard treatment for acute iatrogenic gastrointestinal perforation. However, endoscopic closure has recently emerged as an attractive alternative. In the patient presented herein, the over-the-scope-clipping system (OTSC system) was found to be useful for closing a duodenal perforation that had occurred during endoscopic submucosal dissection. For endoscopists who perform endoscopic treatment of the duodenum, endoscopic closure with the OTSC system is considered to be a technique that is necessary to master.

Treatment of a duodenal perforation after mucosectomy: case report and literature review

“…11 However, ESD as an increased complication rate, and is technically challenging, even in expert hand, due to anatomical duodenal specificitiesthinner duodenal muscular wall, location in retroperitoneum, narrow lumen, rich submucosal vasculature, abundant Brunner's glands that inhibit proper mucosal lifting and submucosal fibrosis and technical difficulties. 3,5,6,8,14 Thermal injury or repeated coagulation, causing ischemic changes in duodenum wall, are also associated. 4,6 Perforation and bleeding are two potential dangerous complications of ESD.…”

“…6 It has a success rate until 87.8%. 5 Completely closing could be difficult, especially in the distal portion of duodenum but, in order to improve outcomes, it is necessary complete closure of the whole mucosal defect. 6,18 Some studies show using those clips to perform prophylactic clipping after endoscopic resection, although some authors don't agree that is sufficient to prevent delayed perforation.…”

“…20 Surgical approach to the duodenum is invasive, and associated with significant morbidity and mortality. 5 Large duodenal perforations can be approached from drainage and pyloric exclusion to pancreaticoduodenectomy.…”

“…1 Their incidence is increasing due to easier access to diagnostic methods, like upper gastrointestinal (GI) endoscopy. [2][3][4][5] Most duodenal NETs are found incidentally during upper GI endoscopic examination. The majority of them are well-differentiated tumors and are located in the first and second portions of the duodenum.…”

The Development of Endoscopic Suturing Devices: Challenges in the Treatment of Iatrogenic Perforation and Bleeding

“…Although a number of reports have demonstrated the successful prophylactic closure of post-duodenal ESD using OTSC, there are few reports on the complete closure of perforation during ESD. In the current issue of this journal, Furukawa et al reported, for the first time, a case in which with closure and hemostasis were simultaneously achieved in a patient with arterial bleeding during duodenal ESD using the OTSC system ( 4 ).…”