Endoscopic clips for the closure of acute iatrogenic perforations: Where do we stand?
OBJECTIVE
Iatrogenic perforation of the gut during endoscopy remains an uncommon but critical complication with significant morbidity and probable mortality than usual surgical treatment. Some authors have adopted a non-surgical closure method in chosen cases and, since 1993, endoclips have been used to close perforation in the stomach. The endoscopic practice of endoclips has been commonly used in the gut for hemostasis. Currently, the use of endoscopic techniques is increasing for the closure of endoscopic submucosal dissection or endoscopic mucosal resection. Endoscopic perforations that improved with endoscopic closure in the literature prior to 2008 have been previously described. In the present article, we present a descriptive review of cases with iatrogenic perforation in the gut treated with endoclips between 2008 and 2014.


METHODS
Comprehensive literature screening and a systematic review using PubMed and Medline was done for all reports published between January 2008 and December 2014 using the endoclip technique in the closure of iatrogenic perforations.


RESULTS
A total of 47 studies published between 2008 and 2014 using endoclips for the closure of iatrogenic perforations of the gut (nine esophagus, 11 stomach, 15 duodenum, 12 colon and rectum) were found. All studies were explained briefly and summarized in a table.


CONCLUSIONS
There is strong evidence to show the efficacy of endoclips in the management of iatrogenic perforations, especially when recognized early. Limitations of endoclipping such as inefficiency against large perforations may be overcome by improving novel techniques in the future.
Department of Gastroenterology, Bolu Izzet Baysal Education and Research Hospital, Bolu.
Bulent
B
Yılmaz
Department of Gastroenterology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Ozan
O
Unlu
Department of Gastroenterology, Cleveland Clinic, Cleveland, USA.
Emir Charles
EC
Roach
Department of Gastroenterology, Bolu Izzet Baysal Education and Research Hospital, Bolu.
Guray
G
Can
Department of Gastroenterology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Cumali
C
Efe
Department of Gastroenterology, Bolu Izzet Baysal Education and Research Hospital, Bolu.
Ugur
U
Korkmaz
Department of Gastroenterology, Bolu Izzet Baysal Education and Research Hospital, Bolu.
Mevlut
M
Kurt
D000208:Acute Disease; D003106:Colon / Q000293:injuries; D004386:Duodenum / Q000293:injuries; D004630:Emergencies; D004724:Endoscopy / Q000295:instrumentation* / Q000379:methods / Q000639:trends; D004939:Esophageal Perforation / Q000209:etiology / Q000601:surgery*; D005260:Female; D005544:Forecasting; D006801:Humans; D007049:Iatrogenic Disease; D007416:Intestinal Perforation / Q000209:etiology / Q000601:surgery*; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D061214:Patient Safety; D012007:Rectum / Q000293:injuries; D013275:Stomach Rupture / Q000209:etiology / Q000601:surgery*; D013525:Surgical Instruments; D016896:Treatment Outcome
endoclip; endoscopic closure; endoscopic procedure; over-the-scope clip; perforation