title: Efficacy of endoscopic closure of acute perforations of the gastrointestinal tract.
abstract: OBJECTIVE
  Acute perforations of the gastrointestinal tract are rare, severe complications of endoscopy that usually require surgical repair. Endoscopic repair of perforations would reduce the need for surgeries; we evaluated the efficacy and safety of endoscopic closure of acute perforations of the gastrointestinal tract by using a new clip device.
  
  
  METHODS
  We conducted a prospective, international, multicenter study of 36 consecutive patients (15 male) with acute iatrogenic perforations (5 esophageal, 6 gastric, 12 duodenal, and 13 colonic perforation). Endoscopic repair was performed by using the Over-the-Scope-Clip according to a standardized operating procedure. Primary end point was successful closure, which was determined as endoscopic successful closure without leakage (detected by water-soluble contrast x-ray analysis), and absence of adverse events within 30 days after the procedure.
  
  
  RESULTS
  Immediate closure was endoscopically successful in 33 patients (92%). One patient developed an esophageal perforation while the cap was introduced, and in 2 patients the perforations did not close; these 3 patients were successfully treated with surgery. None of the patients had leakage of soluble contrast on the basis of contrast x-ray. One patient with a closed colonic perforation deteriorated clinically within 6 hours after the procedure. Despite surgery, the patient died within 36 hours. The remaining 32 patients had successful endoluminal closures; the overall success rate was 89% (95% confidence interval, 75%-96%). The mean endoscopic closure time was 5 minutes 44 seconds ± 4 minutes 15 seconds.
  
  
  CONCLUSIONS
  The Over-the-Scope-Clip is effective for endoluminal closure of acute iatrogenic perforations. It allows patients to avoid surgery, and 89% of patients had successful closures without adverse events.
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Rogier P
authors.initials: RP
authors.lastname: Voermans
authors.forename: Olivier
authors.initials: O
authors.lastname: Le Moine
authors.forename: Daniel
authors.initials: D
authors.lastname: von Renteln
authors.forename: Thierry
authors.initials: T
authors.lastname: Ponchon
authors.forename: Marc
authors.initials: M
authors.lastname: Giovannini
authors.forename: Marco
authors.initials: M
authors.lastname: Bruno
authors.forename: Bas
authors.initials: B
authors.lastname: Weusten
authors.forename: Stefan
authors.initials: S
authors.lastname: Seewald
authors.forename: Guido
authors.initials: G
authors.lastname: Costamagna
authors.forename: Pierre
authors.initials: P
authors.lastname: Deprez
authors.forename: Paul
authors.initials: P
authors.lastname: Fockens
mesh_terms: D000368:Aged; D015331:Cohort Studies; D004724:Endoscopy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome