Endoscopic treatment of gastric perforation caused by acute necrotizing pancreatitis using over-the-scope clips: a case report

Gastric perforation is a rare complication after acute necrotizing pancreatitis. We describe endoscopic closure of a gastric perforation that appeared 4 days after surgical necrosectomy including splenectomy due to necrotizing pancreatitis, using the over-the-scope clip (OTSC) system (Ovesco Endoscopy GmbH, Tübingen, Germany). The clips, which are made of nitinol, are loaded onto an application cap which is mounted on the distal tip of the endoscope. The lesion was closed with two clips and the patient recovered well without reinterventions. The lesions showed normal healing on follow-up.

References

• 1 Baron T H, Morgan D E. Acute necrotizing pancreatitis.  N Engl J Med. 1999;  340 1412-1417
• 2 Katsinelos P, Beltsis A, Paroutoglou G. et al . Endoclipping for gastric perforation after endoscopic polypectomy: an alternative treatment to avoid surgery.  Surg Laparosc Endosc Percutan Tech. 2004;  14 279-281
• 3 Albuquerque W, Arantes V. Large gastric perforation after endoscopic mucosal resection treated by application of metallic clips (video).  Endoscopy. 2004;  36 752-753
• 4 Tsunada S, Ogata S, Ohyama T. et al . Endoscopic closure of perforations caused by EMR in the stomach by application of metallic clips.  Gastrointest Endosc. 2003;  57 948-951
• 5 Minami S, Gotoda T, Ono H. et al . Complete endoscopic closure of gastric perforation induced by endoscopic resection of early gastric cancer using endoclips can prevent surgery (with video).  Gastrointest Endosc. 2006;  63 596-601
• 6 Binmoeller K F, Thonke F, Soehendra N. Endoscopic hemoclip treatment for gastrointestinal bleeding.  Endoscopy. 1993;  25 167-170
• 7 Hsu C M, Ho Y P, Lien J M. et al . Endoscopic mucosal resection using a pure cut and hemoclip method for colonic nonpolypoid neoplasms.  Chang Gung Med J. 2003;  26 586-591
• 8 Peng Y C, Chen S Y, Tung C F. et al . Factors associated with failure of initial endoscopic hemoclip hemostasis for upper gastrointestinal bleeding.  J Clin Gastroenterol. 2006;  40 25-28
• 9 Kirschniak A, Kratt T, Stüker D. et al . A new endoscopic over-the-scope clip system for treatment of lesions and bleeding in the GI tract: first clinical experiences.  Gastrointest Endosc. 2007;  66 162-167