title: Comparison of endoscopic band ligation and endoclip closure of colonic perforation: technical feasibility and efficacy in an ex vivo pig model.
abstract: OBJECTIVE
  Recent reports have indicated several instances of successful treatment of bowel perforation by using endoscopic band ligation (EBL) when treatment with endoclipping is unsuccessful, but this salvage method has not been investigated in any prospective model. Herein we aimed to compare the technical feasibility and efficacy of EBL and endoclip use in intraluminal closure of colon perforation, in an ex vivo model.
  
  
  METHODS
  Standardized colonic perforations were created using fresh porcine colon and subsequently closed by full-thickness interrupted sutures, endoclip (QuickClip2(TM)), or EBL. Each closure site was tested with compressed air by using a digital pressure monitor for evaluating leak pressure.
  
  
  RESULTS
  No significant differences were noted between the endoclip and EBL in leak pressures. Mean (± SD) pressures for air leakage from the perforations closed using the different devices were as follows: normal colon samples, 52.0 ± 13.2 mmHg; perforations closed with hand-sewn sutures, 32.3 ± 8.3 mmHg; perforations closed with endoclipping, 53.5 ± 22.7 mmHg; and perforations closed with EBL, 50.4 ± 12.5 mmHg. Time taken for closure by EBL was significantly less than that for closure by endoclipping (3.2 ± 1.7 min vs 6.8 ± 1.3 min, P < 0.01). Further, the number of devices used to achieve complete closure in the EBL group was lower than that with endoclipping (1.6 ± 0.5 vs 3.7 ± 0.8, P < 0.01).
  
  
  CONCLUSIONS
  Endoluminal closure of a 1.5-cm colon perforation with EBL decreased procedure time and was not inferior in leak pressure compared with endoclipping in this ex vivo porcine model.
authors.affiliation: Internal Medicine, Soon Chun Hyang University College of Medicine, Cheonan Hospital, Cheonan, South Korea.
authors.forename: Tae Hoon
authors.initials: TH
authors.lastname: Lee
authors.forename: Joung-Ho
authors.initials: JH
authors.lastname: Han
authors.forename: Yunho
authors.initials: Y
authors.lastname: Jung
authors.forename: Yoonho
authors.initials: Y
authors.lastname: Jung
authors.forename: Suck-Ho
authors.initials: SH
authors.lastname: Lee
authors.forename: Dae Hoon
authors.initials: DH
authors.lastname: Kim
authors.forename: Ji Yun
authors.initials: JY
authors.lastname: Shin
authors.forename: Tae Soo
authors.initials: TS
authors.lastname: Lee
authors.forename: Myunghwan
authors.initials: M
authors.lastname: Kim
authors.forename: Seok-Hwa
authors.initials: SH
authors.lastname: Choi
authors.forename: Hyun
authors.initials: H
authors.lastname: Kim
authors.forename: Seonmee
authors.initials: S
authors.lastname: Park
authors.forename: Seijin
authors.initials: S
authors.lastname: Youn
mesh_terms: D000818:Animals; D003106:Colon / Q000293:injuries* / Q000601:surgery; D003113:Colonoscopy / Q000379:methods*; D004195:Disease Models, Animal; D005240:Feasibility Studies; D007416:Intestinal Perforation / Q000601:surgery*; D008026:Ligation / Q000379:methods; D013536:Suture Techniques / Q000295:instrumentation*; D013552:Swine; D016896:Treatment Outcome
keywords: colon; colonic perforation; endoclip; endoscopic band ligation; endoscopic treatment