Innovations and brief communications
503
Authors
Yu-Feng Xiao*, Jan-Ying Bai*, Jin Yu, Xian-Long Lin, Xiao-Yan Zhao, Shi-Ming Yang, Chao-Qiang Fan
Institution
Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
Bibliography DOI http://dx.doi.org/ 10.1055/s-0034-1365040 Published online: 28.4.2014 Endoscopy 2014; 46: 503–506 © Georg Thieme Verlag KG Stuttgart · New York ISSN 0013-726X
Background and study aims: Delayed perforation is a rare complication of therapeutic colonoscopy, and it is severe and sometimes lethal. This paper reports on a new minimally invasive method for the treatment of delayed colonic perforation. Patients and methods: Three patients with delayed colonic perforation underwent the therapy, which involved three steps: (1) closure with endoclips and loop, (2) overtube placement, and (3) antibiotic wash through a nasobiliary tube.
Results: The procedure was successful in all three patients and no recurrence was observed during 5 – 41 months of follow-up. Conclusions: Although this study involved only a small number of patients and no control arm, the method involving an overtube appears to be a feasible and effective endoscopic treatment for delayed colonic perforation.
Introduction
Patients and methods
!
!
As a result of the increasing number of therapeutic colonoscopy procedure performed, the number of complications has also increased [1], and perforation is one of the most dangerous and common complications [1]. The incidence of colonoscopic perforation ranges from 0.6 % to 5 % [2]. The mortality rate for colonoscopic perforation can be 13 %, according to a recent report [3]. Delayed perforation occurs within 24 – 48 hours after therapeutic endoscopy, with the colon wall being intact during the endoscopic procedure. Emergency surgery is most commonly required for this complication [4]; however, surgical treatment has its own risks, despite the fact that it is currently the most common management strategy for delayed perforation [5, 6]. A new minimally invasive method was investigated for the treatment of delayed colonic perforation; the method has been called “the endoscopic overtube ap" Fig. 1). This proach for delayed perforation” (● paper reports on three patients who underwent this new endoscopic procedure.
Patients
Corresponding author Shi-Ming Yang, MD or Chao-Qiang Fan, MD Department of Gastroenterology Xinqiao Hospital Third Military Medical University Chongqing 400037 China Fax: +86-023-68774004 [email protected] [email protected]
Between February 2010 and February 2013, 1584 patients underwent therapeutic colonoscopy (1501 endoscopic mucosal resections and 83 endoscopic submucosal dissections). Colonic perforation occurred in 11 patients, 8 with intraprocedural perforation and 3 with delayed perforation. Those with intraoperative perforation were treated during the procedure using endoclips. For the current study, inclusion criteria were age 18 – 80 years, a colorectal perforation within 24 – 48 hours after the therapeutic colonoscopy, local peritonitis and signed informed consent from the patient to undergo the endoscopic intervention. The exclusion criteria were diffuse peritonitis, severe infection with a high fever, and abdominal radiographs showing other diseases as the cause of acute abdominal symptoms. The three cases of delayed perforation met all inclusion criteria and were treated by the new method. This study was approved by the hospital’s internal review board.
Procedure
* These author contributed equally to the study.
A colonoscope (Olympus RCF-Q260JI; Olympus, Tokyo, Japan) was inserted into the colon. Carbon dioxide was used for insufflation. The perforation was treated by applying endoclips (Olympus HX610 – 090; Olympus, Tokyo, Japan) and a loop (di-
Xiao Yu-Feng et al. Treatment of delayed colonic perforation by endoscopic overtube … Endoscopy 2014; 46: 503–506
This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
Endoscopic treatment of delayed colon perforation: the enteroscopy overtube approach
Innovations and brief communications
1
3 2
a
Fig. 1 Endoscopic overtube approach for the treatment of delayed colonic perforation. a Schematic of the procedure. 1, Endoclips are deployed to repair the perforation. 2, The enteroscope overtube is inserted beyond the perforation site and lodged in place by the inflated balloon. Fecal material passes through the overtube and avoids contamination of the perforation
ameter 13 mm, Olympus MAJ-339) to repair the perforation " Fig. 1). When this step was completed, the colonoscope was (● replaced by a single-balloon enteroscope (SBE) (Olympus SIFQ260) within an overtube (Olympus ST-SB1). The SBE and overtube were inserted into the colon until they reached the teniae coli near the ileocecal valve. The SBE was then removed, leaving the overtube in situ. Radiographic imaging was used to check the correct placement of the overtube. The internal end of the overtube incorporates a balloon, which can be inflated or deflated by means of a syringe (50 mL) or suction apparatus, respectively. Approximately 100 mL of air was injected into the balloon, in order to secure it in position within the colorectal canal without causing necrosis. The balloon was deflated every 12 hours and refilled with gas 30 minutes later to prevent necrosis. With the overtube in this position, fecal material could pass through the overtube and avoid contaminating the perforation site. A nasobiliary tube (Boston 4014; Boston Scientific, Natick, Massachusetts, USA) was also placed at the perforation site under endoscopic guidance, and 100 mL of metronidazole was flushed through the nasobili-
site. 3, A nasobiliary tube is used to flush metronidazole over the perforation area in order to reduce inflammation. b The overtube with inflated balloon. c Injection and suction apparatus at the external end of the overtube. 1, One inlet is connected to a syringe with a volume of 50 mL. 2, Tube connecting to the suction apparatus (3).
ary tube every 8 hours in order to reduce inflammation at the perforation site. The overtube and nasobiliary tube were removed only after the following conditions were satisfied: there was no longer evidence of free air under the diaphragm on erect abdominal radiograph, and there was a significant reduction in acute abdominal symptoms.
Results !
" Table 1), and the procedure was Three patients were studied (● " " Fig. e 3 and ● " Fig. e 4, available successful in all three (● Fig. 2; ● online). Abdominal pain and distension improved over 2 days, and the free air under the diaphragm disappeared between post" Table 2). Abdominal ultrasound examinaoperative days 2 – 5 (● tion in one patient showed a limited abscess. Ultrasound-guided puncture was performed for drainage, and the abdominal pain receded. No recurrence of peritonitis symptoms were found after removal of the overtube and nasobiliary tube. All patients were
Xiao Yu-Feng et al. Treatment of delayed colonic perforation by endoscopic overtube … Endoscopy 2014; 46: 503–506
This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
504
Innovations and brief communications
Table 1
Patient
505
Clinical characteristics and colonoscopic treatment of study patients.
Age,
Sex
years
Typical
Disease
symptoms +
LST(flat adenoma)
Endoscopic
Size of
Location of
treatment
perforation, mm
perforation
Blood test, WBC
ESD
3
Sigmoid colon
12.3 × 10 9
1
49
Female
2
77
Male
+
LST (flat adenoma)
ESD
6
Ascending colon
14.5 × 10 9
3
41
Female
+
Colonic polyps (villous adenoma)
EMR
5
Transverse colon
18.7 × 10 9
This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
LST, lateral spreading tumor; ESD, endoscopic submucosal dissection; EMR, endoscopic mucosal resection; WBC, white blood cell.
Fig. 2 The clinical presentation of a patient with delayed colonic perforation (Patient #1 in Table 1). a Pathological changes in the sigmoid prior to initial endoscopic treatment. b The surface of the endoscopic submucosal dissection wound. c Postprocedure, free air was observed under the hemidiaphragm on chest radiography. d The 3-mm perforation was observed during an emergency enteroscopy. e Repair of the perforation using endoclips and loop. f Placement of the overtube (yellow arrow) and the nasobiliary tube (green arrow). g Radiography showed the correct placement of the overtube and nasobiliary tube. h Chest radiography showed that the free air had been absorbed. i A perfect outcome of perforation repair was observed on enteroscopy after 3 months.
Figues e3, e4 and e5 online content viewable at: www.thieme-connect.de
Xiao Yu-Feng et al. Treatment of delayed colonic perforation by endoscopic overtube … Endoscopy 2014; 46: 503–506
Innovations and brief communications
Patient
Symptoms relief
Tubes placement,
Hospital stay,
Follow-up,
Complications and
time, days
days
days
months
recurrence
1
2
19
29
5
None
2
2
9
12
23
None
3
2
5
7
41
None
fasted after treatment and received parenteral nutrition and intravenous antibiotic treatments. No complications were found after the procedure, and there was no relapse in the 5 – 41 " Table 2). months of follow-up (●
Table 2 Clinical outcome of patients in this study.
strong enough to be advanced to the perforation site through the biopsy channel without looping. There are some limitations to this method. It is not suitable for patients who have diffuse peritonitis. A larger sample and control study are needed to further evaluate this procedure before it can be considered for general clinical practice.
Discussion !
The ideal treatment for delayed perforation remains elusive. In the past, the occurrence of a delayed perforation was regarded as a surgical emergency. Surgery is necessary when the bowel preparation is poor [5]. However, not all patients can tolerate surgery, which limits the application of surgical treatment. With the rapid advances in endoscopic technology, endoscopists have been able to use endoscopy to repair intraoperative perforations [7]. Recently, a new method employing Over-The-Scope Clips (OTSC; Ovesco, Tübingen, Germany), which are endoclips constructed from a shape-memory nitinol alloy, has been successful in treating perforations [8, 9]. OTSCs appear to be an effective method of treating complex leaks, fistulae, large perforations, and gastrointestinal bleeding [10]. However, OTSCs remain in vivo for months in most patients [11] and may cause intestinal obstruction [10]. Delayed perforations cannot be treated as easily as intraoperative ones. We therefore believe that our treatment for delayed perforation is effective and ingenious. In our opinion, patients with a delayed perforation can be treated through endoscopic therapy when the following conditions are met: (1) good bowel preparation, with most of the fecal material removed and the colonic bacterial load reduced; (2) diet restriction for 5 days after the therapeutic colonoscopy to avoid possible complications. These conditions provide a basic rehabilitative environment for endoscopic therapy and make endoscopic therapy possible for delayed perforation. However, treating delayed perforation with current endoscopic methods is not easy. Endoclips may easily detach from the perforation due to inflammation. Therefore, the creation of an aseptic environment in which the delayed perforation can heal is the key to success. As the inflammation of the perforation is mainly caused by bacteria in the stool, the method described in this paper is helpful because the overtube protects the perforation site from becoming infected and a nasobiliary tube is used to flush the area with metronidazole in order to reduce inflammation. In the procedure, there are some key points that should be explained. First, the perforation should be closed by endoclips as tightly as possible. This step is important because it affects the concrescence of the perforation, especially when the perforation is located in a confined space. The balloon is then inflated large enough to ensure that the colorectal canal is obstructed, thereby ensuring that the stool is drained through the overtube without touching the damaged tissue at the perforation. Moreover, the di" Fig. e 5, ameter of the balloon is measured in vivo and in vitro (● available online) to ensure an appropriate size is used in the patient. A nasobiliary tube was used as the flush tube because it is
Conclusion !
Although delayed perforation is a rare complication of therapeutic colonoscopy, it has a high rate of morbidity and mortality. The treatment of delayed perforation should be based on the patient’s clinical condition. The endoscopic treatment of delayed perforation has been widely used, and we believe that this method will make a contribution to the endoscopic treatment of perforation. Competing interests: None
Acknowledgment !
This work was supported by the Science Foundation of Xinqiao Hospital, Third Military Medical University (No. 20132004).
References 1 Sagawa T, Kakizaki S, Iizuka H et al. Analysis of colonoscopic perforations at a local clinic and a tertiary hospital. World J Gastroenterol 2012; 18: 4898 – 4904 2 Damore LJ2nd, Rantis PC, Vernava AM3rd et al. Colonoscopic perforations. Etiology, diagnosis, and management. Dis Colon Rectum 1996; 39: 1308 – 1314 3 Lohsiriwat V, Sujarittanakarn S, Akaraviputh T et al. Colonoscopic perforation: A report from World Gastroenterology Organization endoscopy training center in Thailand. World J Gastroenterol 2008; 14: 6722 – 6725 4 Isbister WH. The management of colorectal perforation and peritonitis. Aust N Z J Surg 1997; 67: 804 – 808 5 van der Sluis FJ, Loffeld RJ, Engel AF. Outcome of surgery for colonoscopic perforation. Colorectal Dis 2012; 14: e187 – 190 6 Khan AL, Ah-See AK, Crofts TJ et al. Surgical management of the septic complications of diverticular disease. Ann R Coll Surg Engl 1995; 77: 16 – 20 7 Barbagallo F, Castello G, Latteri S et al. Successful endoscopic repair of an unusual colonic perforation following polypectomy using an endoclip device. World J Gastroenterol 2007; 13: 2889 – 2891 8 Manta R, Manno M, Bertani H et al. Endoscopic treatment of gastrointestinal fistulas using an over-the-scope clip (OTSC) device: case series from a tertiary referral center. Endoscopy 2011; 43: 545 – 548 9 Jayaraman V, Hammerle C, Lo SK et al. Clinical application and outcomes of Over the Scope Clip device: initial US experience in humans. Diagn Ther Endosc 2013; 2013: 381873 10 Baron TH, Song LMWK, Ross A et al. Use of an over-the-scope clipping device: multicenter retrospective results of the first U.S. experience (with videos). Gastrointest Endosc 2012; 76: 202 – 208 11 Voermans RP, Le MoineO, von Renteln D et al. Efficacy of endoscopic closure of acute perforations of the gastrointestinal tract. Clin Gastroenterol Hepatol 2012; 10: 603 – 608
Xiao Yu-Feng et al. Treatment of delayed colonic perforation by endoscopic overtube … Endoscopy 2014; 46: 503–506
This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
506
Copyright of Endoscopy is the property of Georg Thieme Verlag Stuttgart and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
503
Authors
Yu-Feng Xiao*, Jan-Ying Bai*, Jin Yu, Xian-Long Lin, Xiao-Yan Zhao, Shi-Ming Yang, Chao-Qiang Fan
Institution
Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
Bibliography DOI http://dx.doi.org/ 10.1055/s-0034-1365040 Published online: 28.4.2014 Endoscopy 2014; 46: 503–506 © Georg Thieme Verlag KG Stuttgart · New York ISSN 0013-726X
Background and study aims: Delayed perforation is a rare complication of therapeutic colonoscopy, and it is severe and sometimes lethal. This paper reports on a new minimally invasive method for the treatment of delayed colonic perforation. Patients and methods: Three patients with delayed colonic perforation underwent the therapy, which involved three steps: (1) closure with endoclips and loop, (2) overtube placement, and (3) antibiotic wash through a nasobiliary tube.
Results: The procedure was successful in all three patients and no recurrence was observed during 5 – 41 months of follow-up. Conclusions: Although this study involved only a small number of patients and no control arm, the method involving an overtube appears to be a feasible and effective endoscopic treatment for delayed colonic perforation.
Introduction
Patients and methods
!
!
As a result of the increasing number of therapeutic colonoscopy procedure performed, the number of complications has also increased [1], and perforation is one of the most dangerous and common complications [1]. The incidence of colonoscopic perforation ranges from 0.6 % to 5 % [2]. The mortality rate for colonoscopic perforation can be 13 %, according to a recent report [3]. Delayed perforation occurs within 24 – 48 hours after therapeutic endoscopy, with the colon wall being intact during the endoscopic procedure. Emergency surgery is most commonly required for this complication [4]; however, surgical treatment has its own risks, despite the fact that it is currently the most common management strategy for delayed perforation [5, 6]. A new minimally invasive method was investigated for the treatment of delayed colonic perforation; the method has been called “the endoscopic overtube ap" Fig. 1). This proach for delayed perforation” (● paper reports on three patients who underwent this new endoscopic procedure.
Patients
Corresponding author Shi-Ming Yang, MD or Chao-Qiang Fan, MD Department of Gastroenterology Xinqiao Hospital Third Military Medical University Chongqing 400037 China Fax: +86-023-68774004 [email protected] [email protected]
Between February 2010 and February 2013, 1584 patients underwent therapeutic colonoscopy (1501 endoscopic mucosal resections and 83 endoscopic submucosal dissections). Colonic perforation occurred in 11 patients, 8 with intraprocedural perforation and 3 with delayed perforation. Those with intraoperative perforation were treated during the procedure using endoclips. For the current study, inclusion criteria were age 18 – 80 years, a colorectal perforation within 24 – 48 hours after the therapeutic colonoscopy, local peritonitis and signed informed consent from the patient to undergo the endoscopic intervention. The exclusion criteria were diffuse peritonitis, severe infection with a high fever, and abdominal radiographs showing other diseases as the cause of acute abdominal symptoms. The three cases of delayed perforation met all inclusion criteria and were treated by the new method. This study was approved by the hospital’s internal review board.
Procedure
* These author contributed equally to the study.
A colonoscope (Olympus RCF-Q260JI; Olympus, Tokyo, Japan) was inserted into the colon. Carbon dioxide was used for insufflation. The perforation was treated by applying endoclips (Olympus HX610 – 090; Olympus, Tokyo, Japan) and a loop (di-
Xiao Yu-Feng et al. Treatment of delayed colonic perforation by endoscopic overtube … Endoscopy 2014; 46: 503–506
This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
Endoscopic treatment of delayed colon perforation: the enteroscopy overtube approach
Innovations and brief communications
1
3 2
a
Fig. 1 Endoscopic overtube approach for the treatment of delayed colonic perforation. a Schematic of the procedure. 1, Endoclips are deployed to repair the perforation. 2, The enteroscope overtube is inserted beyond the perforation site and lodged in place by the inflated balloon. Fecal material passes through the overtube and avoids contamination of the perforation
ameter 13 mm, Olympus MAJ-339) to repair the perforation " Fig. 1). When this step was completed, the colonoscope was (● replaced by a single-balloon enteroscope (SBE) (Olympus SIFQ260) within an overtube (Olympus ST-SB1). The SBE and overtube were inserted into the colon until they reached the teniae coli near the ileocecal valve. The SBE was then removed, leaving the overtube in situ. Radiographic imaging was used to check the correct placement of the overtube. The internal end of the overtube incorporates a balloon, which can be inflated or deflated by means of a syringe (50 mL) or suction apparatus, respectively. Approximately 100 mL of air was injected into the balloon, in order to secure it in position within the colorectal canal without causing necrosis. The balloon was deflated every 12 hours and refilled with gas 30 minutes later to prevent necrosis. With the overtube in this position, fecal material could pass through the overtube and avoid contaminating the perforation site. A nasobiliary tube (Boston 4014; Boston Scientific, Natick, Massachusetts, USA) was also placed at the perforation site under endoscopic guidance, and 100 mL of metronidazole was flushed through the nasobili-
site. 3, A nasobiliary tube is used to flush metronidazole over the perforation area in order to reduce inflammation. b The overtube with inflated balloon. c Injection and suction apparatus at the external end of the overtube. 1, One inlet is connected to a syringe with a volume of 50 mL. 2, Tube connecting to the suction apparatus (3).
ary tube every 8 hours in order to reduce inflammation at the perforation site. The overtube and nasobiliary tube were removed only after the following conditions were satisfied: there was no longer evidence of free air under the diaphragm on erect abdominal radiograph, and there was a significant reduction in acute abdominal symptoms.
Results !
" Table 1), and the procedure was Three patients were studied (● " " Fig. e 3 and ● " Fig. e 4, available successful in all three (● Fig. 2; ● online). Abdominal pain and distension improved over 2 days, and the free air under the diaphragm disappeared between post" Table 2). Abdominal ultrasound examinaoperative days 2 – 5 (● tion in one patient showed a limited abscess. Ultrasound-guided puncture was performed for drainage, and the abdominal pain receded. No recurrence of peritonitis symptoms were found after removal of the overtube and nasobiliary tube. All patients were
Xiao Yu-Feng et al. Treatment of delayed colonic perforation by endoscopic overtube … Endoscopy 2014; 46: 503–506
This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
504
Innovations and brief communications
Table 1
Patient
505
Clinical characteristics and colonoscopic treatment of study patients.
Age,
Sex
years
Typical
Disease
symptoms +
LST(flat adenoma)
Endoscopic
Size of
Location of
treatment
perforation, mm
perforation
Blood test, WBC
ESD
3
Sigmoid colon
12.3 × 10 9
1
49
Female
2
77
Male
+
LST (flat adenoma)
ESD
6
Ascending colon
14.5 × 10 9
3
41
Female
+
Colonic polyps (villous adenoma)
EMR
5
Transverse colon
18.7 × 10 9
This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
LST, lateral spreading tumor; ESD, endoscopic submucosal dissection; EMR, endoscopic mucosal resection; WBC, white blood cell.
Fig. 2 The clinical presentation of a patient with delayed colonic perforation (Patient #1 in Table 1). a Pathological changes in the sigmoid prior to initial endoscopic treatment. b The surface of the endoscopic submucosal dissection wound. c Postprocedure, free air was observed under the hemidiaphragm on chest radiography. d The 3-mm perforation was observed during an emergency enteroscopy. e Repair of the perforation using endoclips and loop. f Placement of the overtube (yellow arrow) and the nasobiliary tube (green arrow). g Radiography showed the correct placement of the overtube and nasobiliary tube. h Chest radiography showed that the free air had been absorbed. i A perfect outcome of perforation repair was observed on enteroscopy after 3 months.
Figues e3, e4 and e5 online content viewable at: www.thieme-connect.de
Xiao Yu-Feng et al. Treatment of delayed colonic perforation by endoscopic overtube … Endoscopy 2014; 46: 503–506
Innovations and brief communications
Patient
Symptoms relief
Tubes placement,
Hospital stay,
Follow-up,
Complications and
time, days
days
days
months
recurrence
1
2
19
29
5
None
2
2
9
12
23
None
3
2
5
7
41
None
fasted after treatment and received parenteral nutrition and intravenous antibiotic treatments. No complications were found after the procedure, and there was no relapse in the 5 – 41 " Table 2). months of follow-up (●
Table 2 Clinical outcome of patients in this study.
strong enough to be advanced to the perforation site through the biopsy channel without looping. There are some limitations to this method. It is not suitable for patients who have diffuse peritonitis. A larger sample and control study are needed to further evaluate this procedure before it can be considered for general clinical practice.
Discussion !
The ideal treatment for delayed perforation remains elusive. In the past, the occurrence of a delayed perforation was regarded as a surgical emergency. Surgery is necessary when the bowel preparation is poor [5]. However, not all patients can tolerate surgery, which limits the application of surgical treatment. With the rapid advances in endoscopic technology, endoscopists have been able to use endoscopy to repair intraoperative perforations [7]. Recently, a new method employing Over-The-Scope Clips (OTSC; Ovesco, Tübingen, Germany), which are endoclips constructed from a shape-memory nitinol alloy, has been successful in treating perforations [8, 9]. OTSCs appear to be an effective method of treating complex leaks, fistulae, large perforations, and gastrointestinal bleeding [10]. However, OTSCs remain in vivo for months in most patients [11] and may cause intestinal obstruction [10]. Delayed perforations cannot be treated as easily as intraoperative ones. We therefore believe that our treatment for delayed perforation is effective and ingenious. In our opinion, patients with a delayed perforation can be treated through endoscopic therapy when the following conditions are met: (1) good bowel preparation, with most of the fecal material removed and the colonic bacterial load reduced; (2) diet restriction for 5 days after the therapeutic colonoscopy to avoid possible complications. These conditions provide a basic rehabilitative environment for endoscopic therapy and make endoscopic therapy possible for delayed perforation. However, treating delayed perforation with current endoscopic methods is not easy. Endoclips may easily detach from the perforation due to inflammation. Therefore, the creation of an aseptic environment in which the delayed perforation can heal is the key to success. As the inflammation of the perforation is mainly caused by bacteria in the stool, the method described in this paper is helpful because the overtube protects the perforation site from becoming infected and a nasobiliary tube is used to flush the area with metronidazole in order to reduce inflammation. In the procedure, there are some key points that should be explained. First, the perforation should be closed by endoclips as tightly as possible. This step is important because it affects the concrescence of the perforation, especially when the perforation is located in a confined space. The balloon is then inflated large enough to ensure that the colorectal canal is obstructed, thereby ensuring that the stool is drained through the overtube without touching the damaged tissue at the perforation. Moreover, the di" Fig. e 5, ameter of the balloon is measured in vivo and in vitro (● available online) to ensure an appropriate size is used in the patient. A nasobiliary tube was used as the flush tube because it is
Conclusion !
Although delayed perforation is a rare complication of therapeutic colonoscopy, it has a high rate of morbidity and mortality. The treatment of delayed perforation should be based on the patient’s clinical condition. The endoscopic treatment of delayed perforation has been widely used, and we believe that this method will make a contribution to the endoscopic treatment of perforation. Competing interests: None
Acknowledgment !
This work was supported by the Science Foundation of Xinqiao Hospital, Third Military Medical University (No. 20132004).
References 1 Sagawa T, Kakizaki S, Iizuka H et al. Analysis of colonoscopic perforations at a local clinic and a tertiary hospital. World J Gastroenterol 2012; 18: 4898 – 4904 2 Damore LJ2nd, Rantis PC, Vernava AM3rd et al. Colonoscopic perforations. Etiology, diagnosis, and management. Dis Colon Rectum 1996; 39: 1308 – 1314 3 Lohsiriwat V, Sujarittanakarn S, Akaraviputh T et al. Colonoscopic perforation: A report from World Gastroenterology Organization endoscopy training center in Thailand. World J Gastroenterol 2008; 14: 6722 – 6725 4 Isbister WH. The management of colorectal perforation and peritonitis. Aust N Z J Surg 1997; 67: 804 – 808 5 van der Sluis FJ, Loffeld RJ, Engel AF. Outcome of surgery for colonoscopic perforation. Colorectal Dis 2012; 14: e187 – 190 6 Khan AL, Ah-See AK, Crofts TJ et al. Surgical management of the septic complications of diverticular disease. Ann R Coll Surg Engl 1995; 77: 16 – 20 7 Barbagallo F, Castello G, Latteri S et al. Successful endoscopic repair of an unusual colonic perforation following polypectomy using an endoclip device. World J Gastroenterol 2007; 13: 2889 – 2891 8 Manta R, Manno M, Bertani H et al. Endoscopic treatment of gastrointestinal fistulas using an over-the-scope clip (OTSC) device: case series from a tertiary referral center. Endoscopy 2011; 43: 545 – 548 9 Jayaraman V, Hammerle C, Lo SK et al. Clinical application and outcomes of Over the Scope Clip device: initial US experience in humans. Diagn Ther Endosc 2013; 2013: 381873 10 Baron TH, Song LMWK, Ross A et al. Use of an over-the-scope clipping device: multicenter retrospective results of the first U.S. experience (with videos). Gastrointest Endosc 2012; 76: 202 – 208 11 Voermans RP, Le MoineO, von Renteln D et al. Efficacy of endoscopic closure of acute perforations of the gastrointestinal tract. Clin Gastroenterol Hepatol 2012; 10: 603 – 608
Xiao Yu-Feng et al. Treatment of delayed colonic perforation by endoscopic overtube … Endoscopy 2014; 46: 503–506
This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
506
Copyright of Endoscopy is the property of Georg Thieme Verlag Stuttgart and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
