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. 2018 Apr 1:2018:4325675.
doi: 10.1155/2018/4325675. eCollection 2018.

Endoscopic Band Ligation Is Able to Close Perforations Caused by Colonoscopy: A Porcine Model Study

Yidong Yang  1 , Xianyi Lin  1 , Siwei Tan  1 , Xiaoli Huang  1 , Zijun Xie  1 , Xuan Xu  1 , Yiming Lei  1 , Bin Wu  1
Affiliations

Endoscopic Band Ligation Is Able to Close Perforations Caused by Colonoscopy: A Porcine Model Study

Yidong Yang et al. Gastroenterol Res Pract. .

Abstract

Objective: Diagnostic colonoscopy is important for diagnosing colorectal diseases, including inflammatory bowel disease and colorectal tumours. Perforation during diagnostic colonoscopy, a rare but serious complication, is a considerable factor before performing the procedure. Immediate endoluminal closure of a perforation could prevent the adverse consequences associated with general anaesthesia and surgery. This study is aimed at assessing the potential effectiveness and safety of endoscopic band ligation (EBL) in closing a colon perforation during endoscopy in a porcine model.

Methods: Colon perforations were created and then subsequently closed with EBL in six porcine models. After 28 days of careful follow-up, pigs were euthanized for clinical and pathologic evaluations.

Results: All colon perforations were successfully closed using EBL in pigs. The mean time of perforation closure with EBL was 244.3 seconds with one to two bands, and there were no immediate complications or clinical manifestations of peritonitis or sepsis in any animals. No pericolonic abscess or peritonitis was found during necropsy. Histopathology demonstrated reepithelialization of the mucosa at the perforation site.

Conclusions: Immediate closure of perforations caused during colonoscopy with EBL is feasible and safe in a porcine model.

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Figures

Figure 1
Figure 1
Process of colonic perforation creation. (a) A biopsy forceps with needle is first clamped on the colonic wall to fix the coloscope during the creation of the perforation. (b) The schematic plan shows that the coloscope is pushed toward to the colon wall vertically to perforate the colonic wall and create a perforation. (c) A 1.2–1.5 cm full-thickness perforation of the colon is made. (d) The size and full-thickness nature of the perforation are verified by passing the endoscope into the free abdominal cavity.
Figure 2
Figure 2
Follow-up of pigs after the operation with coloscopy. (a) Endoscopic band ligation is used to close the perforation. (b) Follow-up colon endoscopy performed on day 7 showing a white coating with band. (c) On day 14, endoscopy revealed a white coating with band. (d) An internal view of the perforation site by endoscopy shows a completely healed scar.
Figure 3
Figure 3
Results of necropsy. (a) An external view of the perforation site shows no adhesion with other organs on days 14. (b) An internal view of the perforation site shows a white coating with a band. (c) On days 28, a macroscopic view of the external of the perforation site shows no adhesion. (d) Internal view of the perforation sites shows completely healed scars.
Figure 4
Figure 4
Macroscopic view of local adhesion. (a) An external macroscopic view of the perforation site shows local adhesion with a fibrous band and distant adhesion with the small bowel in one case. (b) Magnified view of the adhesion in the perforation site.
Figure 5
Figure 5
Histologic results of the perforation site after EBL. (a) Moderate fibrosis with chronic inflammation is observed in the submucosa (H&E stain, ×100). (b) Fibrotic tissue replaced the defect of the submucosa and muscularis propria (H&E stain, ×100). (c) Infiltration of inflammatory cells and granulation tissue in the submucosa is observed. (H&E stain, ×100). (d) Healing with reepithelialization of the mucosa (H&E stain, ×100).
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