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DOI: 10.1055/a-1333-0620
Large iatrogenic sigmoid colon perforation treated with endoloop-assisted clip closure and over-the-scope clip: a case report
A 77-year-old woman was admitted to our Emergency Department for an iatrogenic sigmoid colon perforation that occurred during a diagnostic colonoscopy. The patient complained of moderate abdominal pain without signs of peritonitis. Considering the time since colonoscopy (< 2 hours) and the excellent bowel preparation, an attempt was made to treat the perforation endoscopically. Therapeutic colonoscopy was performed under monitored anesthesia care using a single-channel therapeutic gastroscope (EG-3490K; Pentax Medical, Tokyo, Japan) and CO2 insufflation. A 6-cm large full-thickness wall defect at 25 cm from the anal verge, with active oozing bleeding, was detected ([Fig. 1]). Bleeding was controlled with 1:10 000 adrenaline injection; thereafter an endoloop-assisted clip closure was performed.
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We opened a 30-mm endoloop (HX-400U-30; Olympus Medical Systems Corp., Tokyo, Japan) around the wall defect; the cable was anchored to the hole margins by launching, one by one, four 13-mm through-the-scope clips (MD-G-HR-230-13-135; Zhejiang Chuangxiang Medical Technology Co., Ltd., Hangzhou, China); then the endoloop was hooked, closed, and finally released ([Fig. 2]). The contrastography showed a 6-mm residual wall defect that was treated deploying a 12-mm t-type over-the-scope clip (OTSC) (Ovesco, Tübingen, Germany), with no contrast agent extravasation at the end. A computed tomography (CT) scan after the procedure confirmed the absence of contrast extravasation on luminal contrastography. The patient was managed conservatively with bowel rest, intravenous fluids, and broad-spectrum antibiotic therapy. After 5 days, oral feeding was resumed and the patient was discharged. A CT scan with colonic contrast injection performed after 3 weeks showed a complete resolution ([Video 1]).
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Video 1 Large iatrogenic sigmoid colon perforation treated with endoloop-assisted clip closure and over-the-scope clip.
Quality:
The endoloop-assisted clip closure technique has been reported as a therapeutic solution for iatrogenic perforations. The timing since the perforation is crucial in order to effectively close the leak [1] [2] [3] [4] [5]. In conclusion, in selected cases, the combined endoscopic rescue therapy with endoloop-assisted clip closure and OTSC can be effective in conservative treatment of colonic perforations.
Endoscopy_UCTN_Code_CPL_1AJ_2AH
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Competing interests
The authors declare that they have no conflict of interest.
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References
- 1 Paspatis GA, Arvanitakis M, Dumonceau JM. et al. Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement – Update 2020. Endoscopy 2020; 52: 792-810
- 2 Ryu JY, Park BK, Kim WS. et al. Endoscopic closure of iatrogenic colon perforation using dual-channel endoscope with an endoloop and clips: methods and feasibility data (with videos). Surg Endosc 2019; 33: 1342-1348
- 3 Dolezel R, Ryska O, Kollar M. et al. A comparison of two endoscopic closures: over-the-scope clip (OTSC) versus KING closure (endoloop + clips) in a randomized long-term experimental study. Surg Endosc 2016; 30: 4910-4916
- 4 Katsinelos P, Lazaraki G, Chatzimavroudis G. et al. Closure of an iatrogenic rectal perforation with the endoloop/clips technique in a purse-string fashion. Ann Gastroenterol 2014; 27: 264
- 5 Hookey LC, Khokhotva V, Bielawska B. et al. The Queen's closure: a novel technique for closure of endoscopic gastrotomy for natural-orifice transluminal endoscopic surgery. Endoscopy 2009; 41: 149-153
Corresponding author
Publication History
Article published online:
27 January 2021
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References
- 1 Paspatis GA, Arvanitakis M, Dumonceau JM. et al. Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement – Update 2020. Endoscopy 2020; 52: 792-810
- 2 Ryu JY, Park BK, Kim WS. et al. Endoscopic closure of iatrogenic colon perforation using dual-channel endoscope with an endoloop and clips: methods and feasibility data (with videos). Surg Endosc 2019; 33: 1342-1348
- 3 Dolezel R, Ryska O, Kollar M. et al. A comparison of two endoscopic closures: over-the-scope clip (OTSC) versus KING closure (endoloop + clips) in a randomized long-term experimental study. Surg Endosc 2016; 30: 4910-4916
- 4 Katsinelos P, Lazaraki G, Chatzimavroudis G. et al. Closure of an iatrogenic rectal perforation with the endoloop/clips technique in a purse-string fashion. Ann Gastroenterol 2014; 27: 264
- 5 Hookey LC, Khokhotva V, Bielawska B. et al. The Queen's closure: a novel technique for closure of endoscopic gastrotomy for natural-orifice transluminal endoscopic surgery. Endoscopy 2009; 41: 149-153
![](https://www.thieme-connect.de/media/endoscopy/202111/thumbnails/10-1055-a-1333-0620-i2105ev1.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
![](https://www.thieme-connect.de/media/endoscopy/202111/thumbnails/10-1055-a-1333-0620-i2105ev2.jpg)
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