New devices and techniques for endoscopic closure of gastrointestinal perforations

Abstract

Gastrointestinal perforations, which need to be managed quickly, are associated with high morbidity and mortality. Treatments used to close these perforations range from surgery to endoscopic therapy. Nowadays, with the development of new devices and techniques, endoscopic therapy is becoming more popular. However, there are different indications and clinical efficacies between different methods, because of the diverse properties of endoscopic devices and techniques. Successful management also depends on other factors, such as the precise location of the perforation, its size and the length of time between the occurrence and diagnosis. In this study, we performed a comprehensive review of various devices and introduced the different techniques that are considered effective to treat gastrointestinal perforations. In addition, we focused on the different methods used to achieve successful closure, based on the literature and our clinical experiences.

Keywords: Devices; Endoscopic closure; Gastrointestinal perforations; Techniques; Treatment.

Figure 1

Over the scope clip system and clips applied to make a successful closure. A: When endoscopic submucosal dissection (ESD) was performed for a lesion located in gastric antrum, a large perforation occurred, which was about 30 mm × 15 mm; B: The omentum majus could be seen through the perforation; C: It was difficult to make complete closure using only endoclips, and the over the scope clip (OTSC) system was applied to close the perforation. However, only partial closure was achieved because the perforation was too large; D: Eight endoclips were then used to make a complete closure.

Figure 2

Successful closure of large perforations in a patients. A: There was a submucosal tumor located in the gastric fundus, which was about 15 mm × 12 mm and originated from the deep muscularis propria; B: An intentional perforation occurred during the procedure for full-thickness resection; C: A larger perforation was left after complete removal of the tumor. However, the mucosa over the tumor was kept intact; D: We use the retained mucosa to cover the perforation and the wound was successfully covered by the intact mucosa combined with several endoclips.