Endoscopic management of colonic perforations: clips versus suturing closure (with videos) Sergey V. Kantsevoy, MD, PhD, Marianne Bitner, CRNA, Gulara.

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Presentation transcript:

Endoscopic management of colonic perforations: clips versus suturing closure (with videos) Sergey V. Kantsevoy, MD, PhD, Marianne Bitner, CRNA, Gulara Hajiyeva, MD, Paulina M. Mirovski, BA, Michael E. Cox, MD, Thomas Swope, MD, Kelly Alexander, MD, Nora Meenaghan, MD, J. Lawrence Fitzpatrick, MD, Vadim Gushchin, MD Gastrointestinal Endoscopy Volume 84, Issue 3, Pages 487-493 (September 2016) DOI: 10.1016/j.gie.2015.08.074 Copyright © 2016 Terms and Conditions

Gastrointestinal Endoscopy 2016 84, 487-493DOI: (10. 1016/j. gie. 2015 Copyright © 2016 Terms and Conditions

Figure 1 Colonic perforation closure with endoscopic clips. A, Large, sessile cecal polyp. B, Full-thickness colonic perforation after polyp removal. C, Perforation closed with endoscopic clips. Gastrointestinal Endoscopy 2016 84, 487-493DOI: (10.1016/j.gie.2015.08.074) Copyright © 2016 Terms and Conditions

Figure 2 Colonic perforation closure with endoscopic suturing. A, Accidental colonic perforation during screening colonoscopy. B, Perforation closed with 1 continuous suturing line. Gastrointestinal Endoscopy 2016 84, 487-493DOI: (10.1016/j.gie.2015.08.074) Copyright © 2016 Terms and Conditions

Figure 3 Closure of a colonic perforation during ESD with an endoscopic suturing device. A, Large, sessile polyp in the descending colon. B, A full-thickness perforation during ESD. C, ESD is completed. D, Double-channel endoscope preloaded with an endoscopic suturing device is advanced toward the ESD site to start suturing. E, Colonic perforation and large mucosal defect after ESD completely closed with 1 continuous suturing line. ESD, endoscopic submucosal dissection. Gastrointestinal Endoscopy 2016 84, 487-493DOI: (10.1016/j.gie.2015.08.074) Copyright © 2016 Terms and Conditions

Figure 4 Follow-up colonoscopy in 3 months demonstrating complete healing of previous perforation and post-ESD defect in the patient in Figure 3. A, Previous perforation and mucosal defect after ESD healed completely. Previously made endoscopic suture is still attached. B, The suture is cut off with endoscopic scissors. C, The suture is removed. There is no residual polypoid tissue. A small granuloma near the site of previous ESD will be removed with endoscopic forceps and sent for histological evaluation. ESD, endoscopic submucosal dissection. Gastrointestinal Endoscopy 2016 84, 487-493DOI: (10.1016/j.gie.2015.08.074) Copyright © 2016 Terms and Conditions