title: Endoscopic band ligation for closure of GI perforations in a porcine animal model (with video).
abstract: BACKGROUND
  GI perforations occur rarely during endoscopy but have life-threatening implications.
  
  
  OBJECTIVE
  To evaluate endoscopic band ligation (EBL) for closure of acute GI perforations by using a porcine model.
  
  
  METHODS
  Investigator-initiated interventional pilot study by using an in vivo porcine model.
  
  
  METHODS
  Tertiary-care institution.
  
  
  METHODS
  Ten domestic pigs.
  
  
  METHODS
  Each animal underwent a single endoscopic procedure, with creation of a single GI lumen perforation. Perforations of 10 to 20 mm were created in the esophagus, stomach, duodenum, and colon. EBL was used for closure. Fourteen days later, the pigs were killed, microbial cultures were obtained, and histologic review was done.
  
  
  METHODS
  Immediate and delayed endoscopic closure of the perforation site, evidence of clinical peritonitis during the 14-day follow-up.
  
  
  RESULTS
  Ten pigs completed the protocol and survived without clinical peritonitis during the 14-day follow-up. Endoscopic closure of a 15-mm esophageal perforation failed, thus, no attempt was made to close a 20-mm esophageal perforation. Closure of all other perforations was successful. At necropsy, fibrinous peritonitis was suspected in one animal with a 10-mm duodenal perforation. Chronic inflammation and fibroplasia at the perforation sites were the most common histologic findings.
  
  
  CONCLUSIONS
  The applicability of widespread use in humans remains unknown despite successful case reports in the medical literature.
  
  
  CONCLUSIONS
  EBL can be used successfully to close 10 to 20 mm perforations within normal stomach, duodenum, and colon and can prevent clinically relevant intra-abdominal infections. However, for esophageal perforations, closure may be limited to small (≤10 mm), iatrogenic perforations.
authors.affiliation: Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Law
authors.affiliation: Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Jodie L
authors.initials: JL
authors.lastname: Deters
authors.affiliation: Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Charles A
authors.initials: CA
authors.lastname: Miller
authors.affiliation: Department of Comparative Medicine, Mayo Clinic, Scottsdale, Arizona, USA.
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Marler
authors.affiliation: Division of Gastroenterology & Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA.
authors.forename: Todd H
authors.initials: TH
authors.lastname: Baron
mesh_terms: D000818:Animals; D003108:Colonic Diseases / Q000601:surgery; D004195:Disease Models, Animal; D004378:Duodenal Diseases / Q000601:surgery; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004939:Esophageal Perforation / Q000503:physiopathology / Q000601:surgery*; D007416:Intestinal Perforation / Q000503:physiopathology / Q000601:surgery*; D008026:Ligation / Q000379:methods; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D010865:Pilot Projects; D012680:Sensitivity and Specificity; D034421:Sus scrofa; D014741:Video Recording