Immediate endoscopic closure of colon perforation by using a prototype endoscopic suturing device: feasibility and outcome in a porcine model (with video).

BACKGROUND Perforation is an uncommon but potentially devastating complication of colonoscopy. Surgical closure is the standard of care. Immediate endoluminal closure of a perforation would avoid the morbidity and mortality associated with general anesthesia, laparotomy, and surgical repair. OBJECTIVES To evaluate the feasibility and safety of full-thickness endoscopic closure of colonic perforations with a prototype endoscopic suturing device, the Eagle Claw, in a porcine model. DESIGN Endoscopic animal experimental study of closure of colon perforation by using a porcine model. SUBJECTS Ten pigs were included in the study. INTERVENTIONS The Eagle Claw was used to close small perforations (1.5 to 2 cm) of the colon created by needle-knife with the animal under general anesthesia by using the endoluminal route. All animals received intravenous antibiotics and were allowed to eat after 24 hours. MAIN OUTCOME MEASUREMENTS The animals were monitored daily for signs of sepsis and peritonitis. On day 7, they were euthanized. The peritoneal cavity was examined for fecal peritonitis, and the colon perforation site was checked for wound dehiscence and pericolic abscess formation. RESULTS Endoscopic closure of the colon perforation was successful in 7 animals, and they recovered well without any sepsis or peritonitis. Necropsy did not reveal fecal peritonitis or pericolonic abscess formation at the site of perforation, and the perforation healed well. Closure was successful in 1 animal, but necropsy revealed dehiscence of the colon perforation site. Endoscopic closure was unsuccessful in 2 animals, and these were euthanized immediately. CONCLUSIONS Closure of acute perforation of the colon is feasible with the Eagle Claw endoscopic suturing device in a porcine model.

[1]  R. Schlinkert.  Laparoscopic treatment of colonoscopic perforations. , 1998, Mayo Clinic proceedings.

[2]  Hisao Tajiri,et al.  Endoscopic full-thickness resection with sutured closure in a porcine model. , 2005, Gastrointestinal endoscopy.

[3]  G. Raju,et al.  A pilot study of endoscopic closure of colonic perforations with endoclips in a swine model. , 2005, Gastrointestinal endoscopy.

[4]  L. Burgart,et al.  First endoluminal system for transmural resection of colorectal tissue with a prototype full-thickness resection device in a porcine model. , 2002, Gastrointestinal endoscopy.

[5]  M. Makuuchi,et al.  Laparoscopic closure for perforation of the sigmoid colon by endoscopic linear stapler. , 1996, Surgical laparoscopy & endoscopy.

[6]  R. Stephens,et al.  Laparoscopic repair of colonic perforation occurring during colonoscopy , 1994, The British journal of surgery.

[7]  Sergey V Kantsevoy,et al.  Eagle Claw II: A novel endosuture device that uses a curved needle for major arterial bleeding: a bench study. , 2005, Gastrointestinal endoscopy.

[8]  R. Chuttani,et al.  A novel endoscopic full-thickness plicator for treatment of GERD: an animal model study. , 2002, Gastrointestinal endoscopy.

[9]  K. Hashiba,et al.  Experimental endoscopic repair of gastric perforations with an omental patch and clips. , 2001, Gastrointestinal endoscopy.

[10]  R. Schlinkert,et al.  Laparoscopic repair of colonoscopic perforations of the colon. , 1994, Journal of laparoendoscopic surgery.

[11]  Sergey V Kantsevoy,et al.  Endoscopic gastrojejunostomy with survival in a porcine model. , 2005, Gastrointestinal endoscopy.

[12]  B. Warren,et al.  Comparison of two closure techniques for the repair of experimental colonic perforations , 1999, The British journal of surgery.

[13]  R. Clements,et al.  Critical Decisions in the Management of Endoscopic Perforations of the Colon , 2000, The American surgeon.

[14]  C. Gostout.  The evolution of endoluminal intervention. , 2005, Gastrointestinal endoscopy.