Controlled trial of immediate endoluminal closure of colon perforations in a porcine model by use of a novel clip device (with videos)

Background Although endoluminal closure of a small perforation of the colon is technically feasible, the outcome of such a closure is unclear. Objective Our purpose was to evaluate the feasibility and the outcome of endoluminal closure of a small perforation of the colon with a novel clip device, th...

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Published in:	Gastrointestinal endoscopy Vol. 64; no. 6; pp. 989 - 997
Main Authors:	Raju, Gottumukkala S., MD, Ahmed, Ijaz, MD, Xiao, Shu-Yuan, MD, Brining, Douglas, DVM, Poussard, Allison, Orhan, Tarcin, MD, Shibukawa, Goro, MD, Dawson, Kristin, Knight, Gary, Tanguay, Randall, Hull, Joanne
Format:	Journal Article
Language:	English
Published:	United States Mosby, Inc 01-12-2006
Subjects:	Animals Colon - injuries Colonoscopes Colonoscopy - adverse effects Colonoscopy - methods Disease Models, Animal Equipment Design Feasibility Studies Gastroenterology and Hepatology Intestinal Perforation - surgery Intestinal Perforation - veterinary Prospective Studies Rupture Suture Techniques - instrumentation Swine Swine Diseases - surgery Treatment Outcome
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Summary:	Background Although endoluminal closure of a small perforation of the colon is technically feasible, the outcome of such a closure is unclear. Objective Our purpose was to evaluate the feasibility and the outcome of endoluminal closure of a small perforation of the colon with a novel clip device, the InScope MultiClip Applier (IMCA), and to assess the number of clips required for successful closure. Design Prospective controlled study. Setting University hospital. Animals 17 pigs. Interventions A 2-cm full-thickness colon perforation was randomized to 3 groups: control, no closure (n = 4), 2-clip closure (n = 7), and 4-clip closure (n = 6). Main Outcome Measurements (1) Technical feasibility of closure, (2) closure time, (3) clinical monitoring for 2 weeks, (4) necropsy (day 14), and (5) healing by a dye leak test and histologic examination. Results Endoscopic closure of the colon perforation was technically successful in 12 of 13 animals. A wide gaping hole prevented satisfactory closure in 1 animal. The median time for closure with 2 and 4 clips was 2 and 3 minutes, respectively. Clip closure of perforation prevented clinical sepsis ( P = .008) and diminished the risk for fibrinous peritonitis ( P = .02 for a single test of hypothesis; however, correction for the multiple testing of data removes this significance) and adhesion formation ( P = .008) compared with controls, without any leakage. The outcomes of 2- and 4-clip closure were similar. Conclusions Endoluminal closure of a 2-cm colon perforation with clips is successful in preventing peritonitis and adhesions and it can be accomplished quickly with this novel device. Clip closure at 1-cm intervals is sufficient for successful closure of a 2-cm colon perforation.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0016-5107 1097-6779
DOI:	10.1016/j.gie.2006.06.058