Is Intraluminal Clip Application an Appropriate Treatment for Iatrogenic Gastric Perforation?

Abstract

Background: The standard treatment of iatrogenic perforation has been an urgent operation. Recently, endoscopic clip application was recommended particularly for iatrogenic perforations. This study was designed to investigate the usage of surgical clips for gastric perforations. Method: Forty male rats were allocated to four groups. Following a midline laparotomy, a 5-mm gastrotomy was made at the fundic part of the stomach and through this ostomy a pre-pyloric perforation was created in all groups. In group I, the perforation site was closed with polypropylene sutures. In group II, the perforation site was closed extraluminally by vascular surgical clips. In group III, the perforation site was closed intraluminally by the same number of clips. In group IV, control group, the perforation site was left open. The animals were sacrificed on the 4th postoperative day. The healing of the perforation site was evaluated by the bursting pressure and the hydroxyproline content of the suture line. Results: Measurements revealed no differences in bursting pressure and hydroxyproline levels between the intraluminal clip application group (group III) and the group in which the perforation site was left open (group IV) (p > 0.05). Higher bursting pressures and hydroxyproline levels were observed in groups I and II compared to control group (p < 0.05). Conclusions: These results suggest that gastric perforations are not strengthened by intraluminal clip application. Further detailed clinical studies are necessary in order to conclude that intraluminal clip application is an appropriate treatment for iatrogenic perforation.

Endoclipping of iatrogenic colonic perforation to avoid surgery

“…Even though colonic perforation occurs rarely after colonoscopy, it is a serious complication [2,[10][11][12]. The standard treatment for these patients is usually still an urgent operative repair of the perforation site [25]. Sometimes, immediate operative intervention is not necessarily mandatory [7].…”

“…Endoscopic repair of colonic perforation has been only described in few cases. Recently, endoscopic clip application was recommended, particularly for iatrogenic perforations [25], in some case reports, and in animal models mainly of the upper gastrointestinal tract [18,19,25,27,28]. Endoscopic clipping is also used to close gastric and colonic openings after invasive procedures in natural orifice translumenal endoscopic surgery (NOTES).…”

“…Endoscopic application of inert metallic clips has been used for haemostasis in gastrointestinal bleeding and for marking of lesions [18][19][20][21][22][23][24]. Recently, endoscopic clip application was recommended, particularly for iatrogenic perforations [25].…”