title: Endoscopic management of colonic perforations: clips versus suturing closure (with videos).
abstract: OBJECTIVE
  Perforation during colonoscopy remains the most worrisome adverse event and usually requires urgent surgical rescue. The aim of this study was to evaluate the feasibility and effectiveness of endoscopic closure of full-thickness colonic perforations.
  
  
  METHODS
  We performed a retrospective analysis of all consecutive patients with endoscopically closed colonic perforations over the past 6 years (2009-2014). Colonic perforations were closed by using endoscopic clips or an endoscopic suturing device. Most patients were admitted for treatment with intravenous antibiotics and kept on bowel rest. If their clinical condition deteriorated, urgent surgery was performed. If patients remained stable, oral feeding was resumed, and patients were discharged with subsequent clinical and endoscopic follow-up.
  
  
  RESULTS
  Twenty-one patients had iatrogenic colonic perforations closed with an endoscopic suturing device or endoscopic clips during the study period. Primary closure of a colonic perforation was performed with endoscopic clips in 5 patients and sutured with an endoscopic suturing device in 16 patients. All 5 patients after clip closure had worsening of abdominal pain and required laparoscopy (4 patients) or rescue colonoscopy with endoscopic suturing closure (1 patient). Two patients had abdominal pain after endoscopic suturing closure, but diagnostic laparoscopy confirmed complete and adequate endoscopic closure of the perforations. The other 15 patients did not require any rescue surgery or laparoscopy after endoscopic suturing. The main limitation of our study is its retrospective, single-center design and relatively small number of patients.
  
  
  CONCLUSIONS
  Endoscopic suturing closure of colonic perforations is technically feasible, eliminates the need for rescue surgery, and appears more effective than closure with hemostatic endoscopic clips.
authors.affiliation: Institute for Digestive Health and Liver Diseases, Mercy Medical Center, Baltimore, Maryland, USA; University of Maryland School of Medicine, Baltimore, Maryland, USA.
authors.forename: Sergey V
authors.initials: SV
authors.lastname: Kantsevoy
authors.affiliation: Institute for Digestive Health and Liver Diseases, Mercy Medical Center, Baltimore, Maryland, USA.
authors.forename: Marianne
authors.initials: M
authors.lastname: Bitner
authors.affiliation: Institute for Digestive Health and Liver Diseases, Mercy Medical Center, Baltimore, Maryland, USA; Harbor Hospital Center, Baltimore, Maryland, USA.
authors.forename: Gulara
authors.initials: G
authors.lastname: Hajiyeva
authors.affiliation: Institute for Digestive Health and Liver Diseases, Mercy Medical Center, Baltimore, Maryland, USA.
authors.forename: Paulina M
authors.initials: PM
authors.lastname: Mirovski
authors.affiliation: Institute for Digestive Health and Liver Diseases, Mercy Medical Center, Baltimore, Maryland, USA.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Cox
authors.affiliation: Center for Minimally Invasive Surgery, Mercy Medical Center, Baltimore, Maryland, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Swope
authors.affiliation: Center for Minimally Invasive Surgery, Mercy Medical Center, Baltimore, Maryland, USA.
authors.forename: Kelly
authors.initials: K
authors.lastname: Alexander
authors.affiliation: Center for Minimally Invasive Surgery, Mercy Medical Center, Baltimore, Maryland, USA.
authors.forename: Nora
authors.initials: N
authors.lastname: Meenaghan
authors.affiliation: Center for Minimally Invasive Surgery, Mercy Medical Center, Baltimore, Maryland, USA.
authors.forename: J Lawrence
authors.initials: JL
authors.lastname: Fitzpatrick
authors.affiliation: Surgical Oncology, Mercy Medical Center, Baltimore, Maryland, USA.
authors.forename: Vadim
authors.initials: V
authors.lastname: Gushchin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003106:Colon / Q000293:injuries / Q000601:surgery; D003108:Colonic Diseases / Q000209:etiology / Q000601:surgery*; D003113:Colonoscopy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013525:Surgical Instruments; D013536:Suture Techniques