Rescue endoscopic band ligation of iatrogenic gastric perforations following failed endoclip closure

Abstract

Iatrogenic gastric perforation is one of the most serious complications during therapeutic endoscopy, despite significant advances in endoscopic techniques and devices. This case study evaluated the clinical efficacy and safety of the rescue endoscopic band ligation (EBL) technique in iatrogenic gastric wall perforation following the failure of primary endoclip closure. Five patients were enrolled in this study. These patients underwent emergency endoscopy following the onset of acute gastric wall perforation during endoscopic procedures. The outcome measurements were primary technical success and immediate or delayed procedure-related complications. Successful endoscopic closure using band ligation was reported in all patients, with no complication occurring. We conclude that EBL may be a feasible and safe alternate technique for the management of acute gastric perforation, especially in cases where closure is difficult with endoclips.

Emergencies after endoscopic procedures

“…In case of large defects, the first clip is the most critical and a recent proposal for certain cases is to perform small incisions around to provide a better grip for the clip [95]. Combined methods are also a good approach for larger defects, for instances, hemoclips plus Endoloop [96,97], plus omental patch [93] or plus band ligation [98]. OTSC system, initially developed for haemostasis, but extensively explored for 'otomies' closure in NOTES [99] are ultimately applied in perforation's closure, using or not specific grasping or anchoring devices to approximate margins before clip release.…”

Retrospective analysis of the effects of continuous intraluminal aspiration on postoperative intestinal fistulas

“…Invasive methods are commonly used to treat fistulas and complications due to anastomotic leakage that develop after surgery for many benign and malignant GI diseases, which previously had only one treatment [5][6][7][8][9][10][11][12]. Because of the high morbidity and mortality of patients with a fistula and/or anastomotic leakage, the search for treatments has continued due to the lack of a demonstrably effective method.…”

“…Today, surgery is still used, but less frequently due to developments in endoscopic technology and assistant's tools. The success of treatments methods that are less invasive and easier than surgery has increased, and reduced complications from these methods have decreased the requirement for surgery remarkably in recent years [5][6][7][8][9][10][11][12]. In this study, we share our experience of patients who received continuous intraluminal aspiration to treat a fistula and anastomotic leakage.…”

Management of gastrointestinal tract perforations

“…In such cases, the recently described band ligation technique can be a useful alternative. 23 However, because of the limited size of the endoscopic cap, only small perforations can be sealed. Important tips for applying the band ligation technique are to maintain adequate distance between the perforation site and the endoscopic banding cap so that the surrounding tissues, including the perforation site, are sufficiently sucked into the banding cap.…”