Endoscopic closure of duodenal perforations by using an over-the-scope clip: a randomized, controlled porcine study

• Published in: Gastrointestinal endoscopy Vol. 71; no. 1; pp. 131 - 138
• Main Authors: von Renteln, Daniel, MD, Rudolph, Hans-Ulrich, MD, Schmidt, Arthur, MD, Vassiliou, Melina C., MD, Caca, Karel, MD
• Format: Journal Article
• Language: English
• Published: Maryland heights, MO Mosby, Inc 2010; Elsevier
• Subjects: Animals; Biological and medical sciences; Disease Models, Animal; Duodenoscopy - methods; Duodenum - injuries; Female; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Intestinal Perforation - surgery; Intestinal Perforation - therapy; Medical sciences; Surgical Instruments; Swine; OTSC; endoscopic mucosal resection; over-the-scope clip; endoscopic submucosal dissection; EMR; ESD; Clip; Vertebrata; Mammalia; Duodenum; Perforation; Gastroenterology; Artiodactyla; Endoscopy; Ungulata; Pig
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2009.07.006

Background Duodenal perforations during diagnostic upper endoscopy are rare; however, when therapeutic techniques are performed, the reported incidence is as great as 2.8%. Surgical repair is usually mandated, but it is associated with significant morbidity and mortality. Objective To compare closure of duodenal perforations by using an over-the-scope clip (OTSC) with a surgical closure. Design Randomized, controlled animal study. Setting Animal facility laboratory. Animals Domestic pigs (24 females). Interventions Large (10-mm) duodenal perforations were created by using an endoscopic needle-knife. The animals were randomly assigned to either open surgical repair (n=12) or endoscopic closure by using the OTSC system (n=12). Pressurized leak tests were performed during necropsy. Main Outcome Measurements One major bleed occurred because of a liver injury during creation of the duodenotomy. Mean time for endoscopic closure was 5 minutes (range, 3-8 min; SD ± 2). No complications occurred during any of the closure procedures. At necropsy, all OTSC and surgical closures demonstrated complete sealing of duodenotomy sites. Pressurized leak tests demonstrated a mean burst pressure of 166 mm Hg (range, 80-260; SD ± 65) for OTSC closures and 143 mm Hg (range, 30-300, SD ± 83) for surgical sutures. Ex vivo intact duodenal specimens exhibited a mean burst pressure of 247 mm Hg (range, 200-300; SD ± 35), which was significantly higher compared with in vivo OTSC and surgical closures ( P < .01). There were no significant differences between burst pressures of OTSC and surgical closures ( P = .461). Limitations Nonsurvival setting. Conclusions Endoscopic closure of duodenal perforations by using the OTSC system is comparable with surgical closure in a nonsurvival porcine model. This technique is easy to perform and seems suitable for repairing duodenal perforations.