Controlled trial of immediate endoluminal closure of colon perforations in a porcine model by use of a novel clip device (with videos).
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.
Raju
Gottumukkala S
GS
University of Texas Medical Branch, Galveston, Texas, USA.
Ahmed
Ijaz
I
Xiao
Shu-Yuan
SY
Brining
Douglas
D
Poussard
Allison
A
Tarcin
Orhan
O
Shibukawa
Goro
G
Dawson
Kristin
K
Knight
Gary
G
Tanguay
Randall
R
Hull
Joanne
J
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