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Hustak R. How to close mucosal incisions? Best Pract Res Clin Gastroenterol 2024; 71:101938. [PMID: 39209420 DOI: 10.1016/j.bpg.2024.101938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 04/20/2024] [Accepted: 06/04/2024] [Indexed: 09/04/2024]
Abstract
This article provides an overview of the techniques for closure of the mucosal entry point following advanced procedures in the third space. The outbreak of natural orifice transluminal endoscopic surgery (NOTES) has significantly impacted the treatment of various benign and malignant conditions. Reliable and secure closure of the mucosal entrance is essential for avoiding serious adverse events. Although small defects are typically closed using through-the-scope clips (TTSCs) or over-the-scope clips (OTSCs), challenges may occur with larger or transmural defects. Alternative methods, such as specialised stitches and full-thickness suturing systems, have been developed to address these challenges with promising results. Each method has its own pros and cons, and the choice of closure technique depends on various factors such as anatomical location, endoscopist expertise, costs, and clinical context. By understanding the technical specifications of each closure device, endoscopists can make decisions that enhance patient outcomes and minimise the risk of complications associated with the approximation of defect edges. Continued research is essential to optimise the evolution of newer closure devices and techniques for advancing NOTES.
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Affiliation(s)
- Rastislav Hustak
- Gastroenterology Department, University Hospital Trnava, Faculty of Health Care and Social Work, Trnava, A. Zarnova 11, Slovak Republic.
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2
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Firkins SA, Simons-Linares R. Management of leakage and fistulas after bariatric surgery. Best Pract Res Clin Gastroenterol 2024; 70:101926. [PMID: 39053976 DOI: 10.1016/j.bpg.2024.101926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 06/04/2024] [Indexed: 07/27/2024]
Affiliation(s)
- Stephen A Firkins
- Bariatric and Metabolic Endoscopy, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Roberto Simons-Linares
- Bariatric and Metabolic Endoscopy, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.
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3
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Maisterra S, Quintana-Carbo S, Aranda H, Calvo M, Farran L, Virgili N, Gornals JB. Successful closure of a refractory gastrobronchial fistula using endoscopic mucosal ablation followed by single loop-and-clips technique. Endoscopy 2023; 55:E944-E945. [PMID: 37604454 PMCID: PMC10442212 DOI: 10.1055/a-2127-4663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Affiliation(s)
- Sandra Maisterra
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Barcelona, Catalonia, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain
- Universitat de Barcelona, Barcelona, Catalonia, Spain
- Gastroesophageal Tumours Functional Unit (UTEG), Hospital Universitari de Bellvitge, Institut Català d’Oncologia, Barcelona, Spain
| | - Sergi Quintana-Carbo
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Barcelona, Catalonia, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain
- Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Humberto Aranda
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain
- Universitat de Barcelona, Barcelona, Catalonia, Spain
- Gastroesophageal Tumours Functional Unit (UTEG), Hospital Universitari de Bellvitge, Institut Català d’Oncologia, Barcelona, Spain
- General and Digestive Surgery Department, Hospital Universitari de Bellvitge, Barcelona, Catalonia, Spain
| | - Mariona Calvo
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain
- Gastroesophageal Tumours Functional Unit (UTEG), Hospital Universitari de Bellvitge, Institut Català d’Oncologia, Barcelona, Spain
- Medical Oncology Department, Institut Català dʼOncología (ICO), Barcelona, Spain
| | - Leandre Farran
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain
- Universitat de Barcelona, Barcelona, Catalonia, Spain
- Gastroesophageal Tumours Functional Unit (UTEG), Hospital Universitari de Bellvitge, Institut Català d’Oncologia, Barcelona, Spain
- General and Digestive Surgery Department, Hospital Universitari de Bellvitge, Barcelona, Catalonia, Spain
| | - Nuria Virgili
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain
- Universitat de Barcelona, Barcelona, Catalonia, Spain
- Gastroesophageal Tumours Functional Unit (UTEG), Hospital Universitari de Bellvitge, Institut Català d’Oncologia, Barcelona, Spain
- Endocrinology and Clinical Nutrition department, Hospital Universitari de Bellvitge, Barcelona, Catalonia, Spain
| | - Joan B. Gornals
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Barcelona, Catalonia, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain
- Universitat de Barcelona, Barcelona, Catalonia, Spain
- Gastroesophageal Tumours Functional Unit (UTEG), Hospital Universitari de Bellvitge, Institut Català d’Oncologia, Barcelona, Spain
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Ozgur I, Yilmaz S, Bhatt A, Holubar SD, Steele SR, Gorgun E. Endoluminal management of colon perforations during advanced endoscopic procedures. Surgery 2023; 173:687-692. [PMID: 36266121 DOI: 10.1016/j.surg.2022.07.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/05/2022] [Accepted: 07/08/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Advanced endoscopic procedures are gaining attraction despite a steep learning curve, need for high dexterity, and potential complications. Colonic perforation is the most concerning adverse event during advanced endoscopic procedures. This study presents our experience on endoluminal management of iatrogenic colonic perforations. METHODS Patients who underwent advanced endoscopic procedures at a quaternary center from 2016 to 2021 were identified. Patients who had colonic perforations during advanced procedures and treated with endoscopic closure/clipping were included. Retrospective chart review was performed. Figures represent frequency (proportion) or median (interquartile range/range). RESULTS There were 22 (2.3%) immediate colonic perforations treated with endoscopic clipping out of 964 advanced endoscopic resections. The median age was 64 (interquartile range = 57-71) years and 50% of the patients were female; 16 (73%) resections were proximal to the splenic flexure. Median polyp size was 36 (20-55) mm. Closure was performed with endoscopic clips in 18 (82%) patients, and over-the-scope clips in 4 patients. Median hospital stay was 0.8 (0-4) days, and 13 (59%) patients were discharged the same day; 2 patients were admitted to the emergency department ≤24 hours of procedure. They underwent subsequent laparoscopic suture repair the same day. No one had segmental colon resection, and there were no complications within postoperative 30 days. Pathology revealed 9 (41%) tubular adenomas, 7 (32%) tubulovillous adenomas, 6 (27%) sessile serrated lesions, and no adenocarcinoma. No recurrence was observed with median follow-up of 24 months (range = 0-90 months). CONCLUSION Endoscopic management is an effective treatment approach for the management of iatrogenic colonic perforations.
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Affiliation(s)
- Ilker Ozgur
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH
| | - Sumeyye Yilmaz
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH
| | - Amit Bhatt
- Department of Gastroenterology and Hepatology, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH
| | - Stefan D Holubar
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH
| | - Scott R Steele
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH
| | - Emre Gorgun
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH.
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Nomura T, Sugimoto S, Temma T, Oyamada J, Ito K, Kamei A. Suturing techniques with endoscopic clips and special devices after endoscopic resection. Dig Endosc 2023; 35:287-301. [PMID: 35997063 DOI: 10.1111/den.14427] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 08/21/2022] [Indexed: 12/07/2022]
Abstract
Endoscopic submucosal dissection is an established method for complete resection of large and early gastrointestinal tumors. However, methods to reduce bleeding, perforation, and other adverse events after endoscopic resection (ER) have not yet been defined. Mucosal defect closure is often performed endoscopically with a clip. Recently, reopenable clips and large-teeth clips have also been developed. The over-the-scope clip enables complete defect closure by withdrawing the endoscope once and attaching the clip. Other methods involve attaching the clip-line or a ring with an anchor to appose the edges of the mucosal defect, followed by the use of an additional clip for defect closure. Since clips are limited by their grasping force and size, other methods, such as endoloop closure, endoscopic ligation with O-ring closure, and the reopenable clip over-the-line method, have been developed. In recent years, techniques often utilized for full-thickness ER of submucosal tumors have been widely used in full-thickness defect closure. Specialized devices and techniques for defect closure have also been developed, including the curved needle and line, stitches, and an endoscopic tack and suture device. These clips and suture devices are applied for defect closure in emergency endoscopy, accidental perforations, and acute and chronic fistulas. Although endoscopic defect closure with clips has a high success rate, endoscopists need to simplify and promote endoscopic closure techniques to prevent adverse events after ER.
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Affiliation(s)
- Tatsuma Nomura
- Department of Gastroenterology, Mie Prefectural Shima Hospital, Mie, Japan.,Department of Gastroenterology, Ise Red Cross Hospital, Mie, Japan
| | - Shinya Sugimoto
- Department of Gastroenterology, Ise Red Cross Hospital, Mie, Japan
| | - Taishi Temma
- Department of Gastroenterology, Ise Red Cross Hospital, Mie, Japan
| | - Jun Oyamada
- Department of Gastroenterology, Ise Red Cross Hospital, Mie, Japan
| | - Keichi Ito
- Department of Gastroenterology, Ise Red Cross Hospital, Mie, Japan
| | - Akira Kamei
- Department of Gastroenterology, Ise Red Cross Hospital, Mie, Japan
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Endoscopic Closure: Tools and Techniques. Gastrointest Endosc Clin N Am 2023; 33:169-182. [PMID: 36375881 DOI: 10.1016/j.giec.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The rapid expansion of third space endoscopy has necessitated development of innovative endoscopic defect closure devices and techniques. This article discusses commonly used endoscopic closure devices and techniques, data on their safety and efficacy, and a description of the authors' own practice patterns.
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Closure of Gastrointestinal Fistulas and Leaks with the Over-the-Scope Clip: Case-Series Analysis. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02714-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Russo S, Grande G, Manta R, Mangiafico S, Bertani H, Pigò F, Conigliaro R. Large iatrogenic sigmoid colon perforation treated with endoloop-assisted clip closure and over-the-scope clip: a case report. Endoscopy 2021; 53:E433-E434. [PMID: 33506466 DOI: 10.1055/a-1333-0620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Salvatore Russo
- Azienda Ospedaliero-Universitaria di Modena, Gastroenterology and Digestive Endoscopy Unit
| | - Giuseppe Grande
- Azienda Ospedaliero-Universitaria di Modena, Gastroenterology and Digestive Endoscopy Unit
| | - Raffaele Manta
- Azienda Ospedaliera di Perugia, Gastroenterology and Digestive Endoscopy Unit
| | - Santi Mangiafico
- Azienda Ospedaliero-Universitaria di Modena, Gastroenterology and Digestive Endoscopy Unit
| | - Helga Bertani
- Azienda Ospedaliero-Universitaria di Modena, Gastroenterology and Digestive Endoscopy Unit
| | - Flavia Pigò
- Azienda Ospedaliero-Universitaria di Modena, Gastroenterology and Digestive Endoscopy Unit
| | - Rita Conigliaro
- Azienda Ospedaliero-Universitaria di Modena, Gastroenterology and Digestive Endoscopy Unit
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Quarta Colosso BM, Inoue H. Closure of mucosal defect with a micro-ring technique: simple, cheap, and effective. VideoGIE 2020; 5:51-52. [PMID: 32051907 PMCID: PMC7004892 DOI: 10.1016/j.vgie.2019.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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Endoscopic management of iatrogenic gastrointestinal perforations. LAPAROSCOPIC, ENDOSCOPIC AND ROBOTIC SURGERY 2019. [DOI: 10.1016/j.lers.2019.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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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. [PMID: 30604267 DOI: 10.1007/s00464-018-06616-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 12/03/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Colon perforation is the most serious complication associated with colonoscopic procedures. We performed a novel purse-string suture technique to close the iatrogenic colonic perforation using dual-channel endoscope with an endoloop and clips. METHODS Iatrogenic colon perforations developed during diagnostic colonoscopy referred to a tertiary hospital over 10 years were considered for this endoscopic closure. An endoloop was inserted through the left channel of the endoscope and placed around the defect. The first clip was placed at the proximal site of the defect through the other channel of the endoscope, and the endoloop was anchored on the mucosa around the defect. Then, subsequent clips were placed next to previous clips and the endoloop was fixed. After the defect was encircled by the endoloop and clips, the rim of the opening was approximated by fastening the endoloop with a purse-string technique. RESULTS A total of 8 patients were admitted to our hospital because of iatrogenic colon perforations during diagnostic colonoscopy. Of these, 2 underwent laparoscopic surgery and 6 underwent endoscopic closure by this novel purse-string suture technique. The estimated diameters of the perforations were 20 mm. All cases were successfully treated in the endoscopy unit without sedation or general anesthesia, and recovered without any complication or subsequent operation. Abdominal pain had nearly resolved within 3 days after the procedure in all patients, and only mild peritonitis was observed. CONCLUSIONS Iatrogenic colon perforation can be treated with a purse-string suture technique using dual-channel endoscope with an endoloop and clips. This technique can be useful for relatively large colon perforations associated with diagnostic colonoscopy.
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Chiu PWY. Future of full thickness resection – Devices, indications, robotics, what is missing. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2019. [DOI: 10.1016/j.tgie.2019.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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