title: Endoluminal suturing may overcome the limitations of clip closure of a gaping wide colon perforation (with videos).
abstract: BACKGROUND
  It is unclear whether large gaping perforations of the colon can be closed by the endoluminal route.
  
  
  OBJECTIVE
  To evaluate the feasibility and the outcome of closure of large perforations of colon with clips and sutures by using through-the-endoscope novel devices.
  
  
  METHODS
  Prospective animal study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Ten pigs.
  
  
  METHODS
  Closure of a 4-cm full-thickness colon perforation freshly created by an insulated-tip knife with the InScope Multi-Clip Applier (n = 6) and with the tissue approximation device (n = 4).
  
  
  METHODS
  (a) Technical feasibility of closure, (b) clinical monitoring for 2 weeks, (c) necropsy (day 14), (d) healing by a dye-leak test and histology.
  
  
  RESULTS
  Endoluminal closure of a 4-cm-long colon perforation was successful in 9 of 10 animals. The clips failed to close a gaping wide colon perforation in 1 animal. The sutures were successful in the closure of both nongaping and gaping perforations. Successful closure resulted in a leakproof sealing at 2 weeks and prevented clinical peritonitis in all the animals in the clip-closure group and in 3 of 4 animals in the suture-closure group. Necropsy at 2 weeks revealed mild peritonitis in 2 of the 5 animals in the clip closure group and in 2 of the 4 animals in the suture-closure group; none developed fecal peritonitis.
  
  
  CONCLUSIONS
  None.
  
  
  CONCLUSIONS
  Endoluminal closure of a 4-cm colon perforation with clips was successful in the majority of cases. Sutures were useful in the closure of gaping colon perforations that could not be closed with clips.
authors.affiliation: Center for Endoscopic Research, Training, and Innovation (CERTAIN), University of Texas Medical Branch, Galveston, Texas 77555-0764, USA.
authors.forename: Gottumukkala S
authors.initials: GS
authors.lastname: Raju
authors.forename: Goro
authors.initials: G
authors.lastname: Shibukawa
authors.forename: Ijaz
authors.initials: I
authors.lastname: Ahmed
authors.forename: Douglas
authors.initials: D
authors.lastname: Brining
authors.forename: Allison
authors.initials: A
authors.lastname: Poussard
authors.forename: Shu-Yuan
authors.initials: SY
authors.lastname: Xiao
authors.forename: Jonathan
authors.initials: J
authors.lastname: Coe
authors.forename: Mike
authors.initials: M
authors.lastname: Cropper
authors.forename: Dave
authors.initials: D
authors.lastname: Martin
authors.forename: Joanne
authors.initials: J
authors.lastname: Hull
mesh_terms: D000818:Animals; D003106:Colon / Q000293:injuries* / Q000601:surgery*; D020685:Colonoscopes; D003113:Colonoscopy; D004195:Disease Models, Animal; D004867:Equipment Design; D005240:Feasibility Studies; D007416:Intestinal Perforation / Q000601:surgery*; D011446:Prospective Studies; D013525:Surgical Instruments; D013536:Suture Techniques / Q000295:instrumentation*; D013552:Swine; D016896:Treatment Outcome; D014945:Wound Healing