Cap-assisted clip closure of large esophageal perforations caused by a duodenoscope during endoscopic retrograde cholangiopancreatography (with video).
OBJECTIVE
Esophageal perforation is a rare complication of endoscopic retrograde cholangiopancreatography and the perforation is usually too large to close with endoclips. We developed an endoscopic procedure for the perforations.


METHODS
A gastroscope fitted with a cap was inserted into the esophagus to perform the clip closure. The closure procedure was divided in 3 steps: step 1 is large clip closure; step 2 is small clip closure; and step 3 is the nasogastric tube placement for drainage.


RESULTS
A total of 4 patients underwent a cap-assisted clip closure and the procedures were completed successfully within 30 minutes. The cure was achieved in all the 4 patients after a relatively short period of hospital stay and no patient complained of closure-related complication.


CONCLUSIONS
The cap-assisted clip closure procedure is effective, safe, and easy to carry out for the closure of large esophageal perforations. It may also be applied to perform the closure of large perforations at other sites of the digestive tract.
*Digestive Medical Center, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province †Division of Digestive Diseases, The People's Hospital of Ma Anshan, Ma Anshan City, Anhui Province, China.
Jin
J
Huang
Wei
W
Wen
Xiaowei
X
Tang
Zhining
Z
Fan
Hanming
H
Song
Kuangjing
K
Wang
D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects* / Q000295:instrumentation; D020698:Duodenoscopes / Q000009:adverse effects*; D004384:Duodenoscopy / Q000009:adverse effects* / Q000295:instrumentation; D004939:Esophageal Perforation / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D004947:Esophagus / Q000293:injuries*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D013536:Suture Techniques / Q000295:instrumentation*