title: Controlled trial of immediate endoluminal closure of colon perforations in a porcine model by use of a novel clip device (with videos).
abstract: BACKGROUND
  Although endoluminal closure of a small perforation of the colon is technically feasible, the outcome of such a closure is unclear.
  
  
  OBJECTIVE
  Our purpose was to evaluate the feasibility and the outcome of endoluminal closure of a small perforation of the colon with a novel clip device, the InScope MultiClip Applier (IMCA), and to assess the number of clips required for successful closure.
  
  
  METHODS
  Prospective controlled study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  17 pigs.
  
  
  METHODS
  A 2-cm full-thickness colon perforation was randomized to 3 groups: control, no closure (n = 4), 2-clip closure (n = 7), and 4-clip closure (n = 6).
  
  
  METHODS
  (1) Technical feasibility of closure, (2) closure time, (3) clinical monitoring for 2 weeks, (4) necropsy (day 14), and (5) healing by a dye leak test and histologic examination.
  
  
  RESULTS
  Endoscopic closure of the colon perforation was technically successful in 12 of 13 animals. A wide gaping hole prevented satisfactory closure in 1 animal. The median time for closure with 2 and 4 clips was 2 and 3 minutes, respectively. Clip closure of perforation prevented clinical sepsis (P = .008) and diminished the risk for fibrinous peritonitis (P = .02 for a single test of hypothesis; however, correction for the multiple testing of data removes this significance) and adhesion formation (P = .008) compared with controls, without any leakage. The outcomes of 2- and 4-clip closure were similar.
  
  
  CONCLUSIONS
  Endoluminal closure of a 2-cm colon perforation with clips is successful in preventing peritonitis and adhesions and it can be accomplished quickly with this novel device. Clip closure at 1-cm intervals is sufficient for successful closure of a 2-cm colon perforation.
authors.affiliation: University of Texas Medical Branch, Galveston, Texas, USA.
authors.forename: Gottumukkala S
authors.initials: GS
authors.lastname: Raju
authors.forename: Ijaz
authors.initials: I
authors.lastname: Ahmed
authors.forename: Shu-Yuan
authors.initials: SY
authors.lastname: Xiao
authors.forename: Douglas
authors.initials: D
authors.lastname: Brining
authors.forename: Allison
authors.initials: A
authors.lastname: Poussard
authors.forename: Orhan
authors.initials: O
authors.lastname: Tarcin
authors.forename: Goro
authors.initials: G
authors.lastname: Shibukawa
authors.forename: Kristin
authors.initials: K
authors.lastname: Dawson
authors.forename: Gary
authors.initials: G
authors.lastname: Knight
authors.forename: Randall
authors.initials: R
authors.lastname: Tanguay
authors.forename: Joanne
authors.initials: J
authors.lastname: Hull
mesh_terms: D000818:Animals; D003106:Colon / Q000293:injuries*; D020685:Colonoscopes; D003113:Colonoscopy / Q000009:adverse effects / Q000379:methods*; D004195:Disease Models, Animal; D004867:Equipment Design; D005240:Feasibility Studies; D007416:Intestinal Perforation / Q000601:surgery* / Q000662:veterinary; D011446:Prospective Studies; D012421:Rupture; D013536:Suture Techniques / Q000295:instrumentation*; D013552:Swine; D013553:Swine Diseases / Q000601:surgery*; D016896:Treatment Outcome; D014741:Video Recording