Endoluminal suturing may overcome the limitations of clip closure of a gaping wide colon perforation (with videos)

Background: It is unclear whether large gaping perforations of the colon can be closed by the endoluminal route. Objective: To evaluate the feasibility and the outcome of closure of large perforations of colon with clips and sutures by using through-the-endoscope novel devices. Design: Prospective animal study. Setting: University hospital. Patients: Ten pigs. Interventions: Closure of a 4-cm full-thickness colon perforation freshly created by an insulated-tip knife with the InScope Multi-Clip Applier (n = 6) and with the tissue approximation device (n = 4). Main Outcome Measurements: (a) Technical feasibility of closure, (b) clinical monitoring for 2 weeks, (c) necropsy (day 14), (d) healing by a dye-leak test and histology. Results Endoluminal closure of a 4-cm-long colon perforation was successful in 9 of 10 animals. The clips failed to close a gaping wide colon perforation in 1 animal. The sutures were successful in the closure of both non-gaping and gaping perforations. Successful closure resulted in a leakproof sealing at 2 weeks and prevented clinical peritonitis in all the animals in the clip-closure group and in 3 of 4 animals in the suture-closure group. Necropsy at 2 weeks revealed mild peritonitis in 2 of the 5 animals in the clip closure group and in 2 of the 4 animals in the suture-closure group; none developed fecal peritonitis. Limitations: None. Conclusions: Endoluminal Closure of a 4-cm colon perforation with clips was successful in the majority of cases. Sutures were useful in the Closure of gaping colon perforations that could not be closed with clips.