Closure of gastrointestinal perforations using an endoloop system and a single-channel endoscope: description of a simple, reproducible, and standardized method,Surgical Endoscopy

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Closure of gastrointestinal perforations using an endoloop system and a single-channel endoscope: description of a simple, reproducible, and standardized method
Surgical Endoscopy ( IF 2.4 ) Pub Date : 2024-01-19 , DOI: 10.1007/s00464-023-10654-1
Flavius-Stefan Marin _{1,

2} , Antoine Assaf _{1,

3} , Paul Doumbe-Mandengue ₁ , Einas Abou Ali ₁ , Arthur Belle ₁ , Romain Coriat _{1,

3} , Stanislas Chaussade _{1,

3}

Affiliation

Background

Several endoscopic treatments for iatrogenic perforations are currently available, with some limitations in terms of size, location, complexity, or cost. Our aims were to introduce a novel technique for closure, using an endoloop and clips, to assess its rate of technical success and post-resection complications.

Methods

For closure of large perforations (diameter ≥ 10 mm), two similar techniques were implemented, using a single-channel endoscope. An endoloop was deployed through the operating channel or towed by an endoclip alongside the endoscope. Several clips were utilized to fix it on the muscular layer of defect’s margins. The defect was closed, by fastening the loop either directly or after being reattached to the mobile hook.

Results

This analysis included eleven patients (72% women, median age 68 years). Eight colorectal, one appendiceal, and two gastric lesions were resected, with a median perforation size of 15 mm. As confirmed by computed tomography, closure of wall defects was achieved successfully in all cases, using a median of 6 clips. Pneumoperitoneum was evacuated in 4 cases. The median hospitalization duration was 4 days, prophylactic antibiotics being prescribed for a median of 7 days. One patient had a small abdominal collection, without requiring drainage, while another presented post-resection bleeding from the mucosal defect.

Conclusion

The novel techniques, utilizing a single-channel endoscope, clips, and an endoloop, ensuring an edge-to-edge suture of muscular layer, proved to be safe, reproducible, and easy to implement. They exhibit an excellent technical success rate and a minimal incidence of non-severe complications.

中文翻译：

使用内循环系统和单通道内窥镜闭合胃肠穿孔：简单、可重复和标准化方法的描述

背景

目前有几种治疗医源性穿孔的内窥镜治疗方法，但在尺寸、位置、复杂性或成本方面存在一些限制。我们的目标是引入一种使用内循环和夹子的新颖闭合技术，以评估其技术成功率和切除后并发症。

方法

为了闭合大穿孔（直径≥10毫米），使用单通道内窥镜实施了两种类似的技术。内环通过手术通道展开，或通过内窥镜沿着内窥镜拖动。使用几个夹子将其固定在缺损边缘的肌肉层上。通过直接紧固环或在将其重新连接到移动钩上后，缺陷被闭合。

结果

该分析包括 11 名患者（72% 为女性，中位年龄 68 岁）。切除了 8 个结直肠病灶、1 个阑尾病灶和 2 个胃病灶，穿孔中位尺寸为 15 毫米。经计算机断层扫描证实，在所有病例中，平均使用 6 个夹子成功闭合了壁缺陷。腹腔积气4例。中位住院时间为 4 天，预防性使用抗生素的中位时间为 7 天。一名患者腹部有少量积液，无需引流，而另一名患者则因粘膜缺损出现切除后出血。