Endoluminal closure of large perforations of colon with clips in a porcine model (with video)

Background: Endoluminal clip closure of small perforations of the colon is possible. It is unclear whether large perforations of the colon can be closed with clips deployed through a colonoscope. Objectives: To evaluate the technical feasibility and outcome of endoluminal closure of large perforations of the colon with clips. Design: Pilot study. Subjects: Eight pigs. Interventions: Endoluminal clip closure of large perforations of the colon. Main Outcome Measurements: Technical feasibility of endoluminal closure was evaluated in 8 animals. A dye leak test was performed to evaluate quality of endoluminal sealing immediately after closure and 2 weeks after closure. The animals in the survival group were monitored daily for 2 weeks for sepsis and peritonitis. Necropsy was done on day 14 to check for fecal peritonitis, wound dehiscence, and histological healing of perforation. Results: Endoscopic closure of colon perforation was successful in 6 of 8 animals; in 2 animals closure was unsuccessful due to prolapse of adjacent viscera into the colon (n = 1) and severe bleeding that obscured the view (n = 1). There was a leak-proof sealing of the perforation site in 2 animals tested immediately and in all the animals tested (n = 3) 2 weeks after closure. All 4 animals in the survival group recovered well, without any sepsis or peritonitis. Necropsy did not reveal fecal peritonitis or pericolonic abscess formation. The perforation site demonstrated a thin scar and there was histological healing. Conclusions: Endoluminal application of clips is successful in the closure of a large perforation of the colon in a porcine model.