Endoscopic closure of iatrogenic gastrointestinal tract perforations with the over-the-scope clip

Background: Newer techniques such as mucosal resection, submucosal dissection and risky polypectomy will probably lead to increasing numbers of iatrogenic perforations. Reliable immediate closure of these lesions would increase safety and acceptance of the interventions.

Methods: All acute directly observed perforations during diagnostic or therapeutic endoscopy were treated by the application of an over-the-scope clip. All consecutive patients from 2009 to August 2011 were followed in our tertiary referral center. The main outcome was technically successful closure of the perforation during endoscopy with a subsequent clinical observation for 24 h.

Results: During the observation period, acute perforation occurred in 14 patients. All but 1 patient had technically successful treatment. Due to persistent abdominal pain, 3 patients had to be sent to the theater for laparoscopic evaluation after colon perforation. These 3 lesions were proven to be sealed and no resection of the colon was indicated. One patient with gastric adenocarcinoma had to be resected subtotally following endoscopic mucosal resection. Hospital stay ranged from 2 to 21 days.

Conclusion: Directly observed perforations up to 30 mm diameter during endoscopy should be treated by deploying an over-the-scope clip. Endoscopists should be encouraged to be trained and to use over-the-scope clips in the stomach, duodenum and colon.