Endoscopic closure of duodenal perforations by using an over-the-scope clip: a randomized, controlled porcine study.
BACKGROUND
Duodenal perforations during diagnostic upper endoscopy are rare; however, when therapeutic techniques are performed, the reported incidence is as great as 2.8%. Surgical repair is usually mandated, but it is associated with significant morbidity and mortality.


OBJECTIVE
To compare closure of duodenal perforations by using an over-the-scope clip (OTSC) with a surgical closure.


METHODS
Randomized, controlled animal study.


METHODS
Animal facility laboratory.


METHODS
Domestic pigs (24 females).


METHODS
Large (10-mm) duodenal perforations were created by using an endoscopic needle-knife. The animals were randomly assigned to either open surgical repair (n=12) or endoscopic closure by using the OTSC system (n=12). Pressurized leak tests were performed during necropsy.


METHODS
One major bleed occurred because of a liver injury during creation of the duodenotomy. Mean time for endoscopic closure was 5 minutes (range, 3-8 min; SD +/- 2). No complications occurred during any of the closure procedures. At necropsy, all OTSC and surgical closures demonstrated complete sealing of duodenotomy sites. Pressurized leak tests demonstrated a mean burst pressure of 166 mm Hg (range, 80-260; SD +/- 65) for OTSC closures and 143 mm Hg (range, 30-300, SD +/- 83) for surgical sutures. Ex vivo intact duodenal specimens exhibited a mean burst pressure of 247 mm Hg (range, 200-300; SD +/- 35), which was significantly higher compared with in vivo OTSC and surgical closures (P < .01). There were no significant differences between burst pressures of OTSC and surgical closures (P = .461).


CONCLUSIONS
Nonsurvival setting.


CONCLUSIONS
Endoscopic closure of duodenal perforations by using the OTSC system is comparable with surgical closure in a nonsurvival porcine model. This technique is easy to perform and seems suitable for repairing duodenal perforations.
von Renteln
Daniel
D
Department of Gastroenterology, Medizinische Klinik I, Klinikum Ludwigsburg, Ludwigsburg, Germany. renteln@gmx.net
Rudolph
Hans-Ulrich
HU
Schmidt
Arthur
A
Vassiliou
Melina C
MC
Caca
Karel
K
D000818:Animals; D004195:Disease Models, Animal; D004384:Duodenoscopy / Q000379:methods*; D004386:Duodenum / Q000293:injuries*; D005260:Female; D007416:Intestinal Perforation / Q000601:surgery / Q000628:therapy*; D013525:Surgical Instruments; D013552:Swine