- 作者：Rogier P. Voermans鈦?/sup> ; Olivier Le Moine&Dagger ; ; Daniel von Renteln§ ; ; Thierry Ponchon鈭?/sup> ; Marc Giovannini¶ ; ; Marco Bruno# ; Bas Weusten ; Stefan Seewald&Dagger ; &Dagger ; ; Guido Costamagna§ ; § ; ; Pierre Deprez鈭モ垾 ; Paul Fockens鈦?/sup> ; p.fockens@amc.nl ; CLIPPER Study Group
- 关键词：Clinical Trial ; Humans ; Endoscopy ; Gastrointestinal ; Wound Closure Techniques ; Complications ; Intestinal Perforation ; Esophageal Perforation ; Natural Orifice Endoscopic Surgery ; Closure Technique ; Surgical
- 刊名：Clinical Gastroenterology and Hepatology
- 出版年：2012
- 期刊代码：pca92_15423565
- 类别：med
- 出版时间：June, 2012
- 卷：10
- 期：6
- 页码：603-608
- 文件大小：607 K
Background & Aims
Acute perforations of the gastrointestinal tract are rare, severe complications of endoscopy that usually require surgical repair. Endoscopic repair of perforations would reduce the need for surgeries; we evaluated the efficacy and safety of endoscopic closure of acute perforations of the gastrointestinal tract by using a new clip device.Methods
We conducted a prospective, international, multicenter study of 36 consecutive patients (15 male) with acute iatrogenic perforations (5 esophageal, 6 gastric, 12 duodenal, and 13 colonic perforation). Endoscopic repair was performed by using the Over-the-Scope-Clip according to a standardized operating procedure. Primary end point was successful closure, which was determined as endoscopic successful closure without leakage (detected by water-soluble contrast x-ray analysis), and absence of adverse events within 30 days after the procedure.
Results
Immediate closure was endoscopically successful in 33 patients (92%). One patient developed an esophageal perforation while the cap was introduced, and in 2 patients the perforations did not close; these 3 patients were successfully treated with surgery. None of the patients had leakage of soluble contrast on the basis of contrast x-ray. One patient with a closed colonic perforation deteriorated clinically within 6 hours after the procedure. Despite surgery, the patient died within 36 hours. The remaining 32 patients had successful endoluminal closures; the overall success rate was 89%(95%confidence interval, 75%-96%). The mean endoscopic closure time was 5 minutes 44 seconds 卤 4 minutes 15 seconds.
Conclusions
The Over-the-Scope-Clip is effective for endoluminal closure of acute iatrogenic perforations. It allows patients to avoid surgery, and 89%of patients had successful closures without adverse events.