Clips Close Inadvertent Colonoscopy Perforations

A new technique closes accidental colonoscopy wounds soon after they are identified, thus avoiding invasive surgery.

Following a series of animal studies, researchers at the University of Texas Medical Branch (UTMB; Galveston, USA) developed a technique for closing perforations promptly after they are recognized by using clips or sutures that can be inserted through the anus via endoscope. Similar clips and sutures have been used for some time by surgeons performing minimally invasive laparoscopic procedures, including several gynecologic operations and other procedures such as gall bladder removal.

During colonoscopies, surgeons may accidentally cause two principal types of perforations; one results from overstretching the colon, the other from removal of polyps. Working with pigs as an experimental model, the researchers successfully closed colon perforations of less than one inch with small metal clips inserted via endoscopes. The new technique was presented at the annual meeting of the American Society of Gastrointestinal Endoscopy, held during May 2007 in Washington DC (USA).

"We have shown in a series of experiments that both types of perforations can be closed successfully using an endoscope without the need for invasive surgery,” said lead author, UTMB associate professor of gastroenterology G.S. Raju, M.D. "We have even accomplished a leak-proof seal of the perforation.”

In one out of every 1,000 to 2,000 colonoscopies, doctors inadvertently perforate the colon. Most of these patients need urgent surgery to close the wound and spend 10 days in the hospital. One in 10 dies, usually because delays in closing perforations allow colon contents to leak into the abdominal cavity, causing deadly conditions such as peritonitis and sepsis.


Related Links:
University of Texas Medical Branch