内镜下用连续的镜外夹包括后屈曲部署闭合全层横结肠穿孔

Q3 Medicine

VideoGIE Pub Date : 2025-10-01 DOI:10.1016/j.vgie.2025.05.008

Vanisha Patel MD, Suraj Pai MD, Erica Park MD, Raj Shah MD, Somashekar G. Krishna MD, Georgios I. Papachristou MD, Jordan Burlen MD

{"title":"内镜下用连续的镜外夹包括后屈曲部署闭合全层横结肠穿孔","authors":"Vanisha Patel MD, Suraj Pai MD, Erica Park MD, Raj Shah MD, Somashekar G. Krishna MD, Georgios I. Papachristou MD, Jordan Burlen MD","doi":"10.1016/j.vgie.2025.05.008","DOIUrl":null,"url":null,"abstract":"<div><h3>Background and Aims</h3><div>Endoscopic mucosal resection (EMR) poses a risk of iatrogenic colonic perforation. In this case, we discuss the endoscopic closure of a colonic perforation with sequential over-the-scope clips (OTSCs), one of which was deployed in retroflexion.</div></div><div><h3>Methods</h3><div>A 61-year-old patient presented for EMR of a transverse colon polyp. Lifting agent injection provided inadequate lift, so underwater EMR was performed with a hot snare. After en bloc polypectomy, a full-thickness perforation was found. We review our perforation closure technique, including an unsuccessful attempt with through-the-scope clips followed by successful closure with sequential OTSCs.</div></div><div><h3>Results</h3><div>Approximation of defect edges with through-the-scope clips was technically challenging because of location and width of the defect. Ultimately, the perforation was closed with 2 OTSCs. A retroflexed examination of the defect with gastroscope found a persistent defect along the posterior aspect. The remaining area was closed with a third OTSC deployed in retroflexion.</div></div><div><h3>Conclusions</h3><div>This case highlights use of sequential OTSCs, including one deployed in retroflexion to successfully close a large, full-thickness transverse colonic perforation following an EMR. We describe modified positioning of the OTSC that enabled more tissue acquisition with clip deployment. The patient did well postprocedurally, without need for surgical intervention.</div></div>","PeriodicalId":55855,"journal":{"name":"VideoGIE","volume":"10 10","pages":"Pages 544-547"},"PeriodicalIF":0.0000,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Endoscopic closure of full-thickness transverse colon perforation with sequential over-the-scope clips including retroflexed deployment\",\"authors\":\"Vanisha Patel MD, Suraj Pai MD, Erica Park MD, Raj Shah MD, Somashekar G. Krishna MD, Georgios I. Papachristou MD, Jordan Burlen MD\",\"doi\":\"10.1016/j.vgie.2025.05.008\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background and Aims</h3><div>Endoscopic mucosal resection (EMR) poses a risk of iatrogenic colonic perforation. In this case, we discuss the endoscopic closure of a colonic perforation with sequential over-the-scope clips (OTSCs), one of which was deployed in retroflexion.</div></div><div><h3>Methods</h3><div>A 61-year-old patient presented for EMR of a transverse colon polyp. Lifting agent injection provided inadequate lift, so underwater EMR was performed with a hot snare. After en bloc polypectomy, a full-thickness perforation was found. We review our perforation closure technique, including an unsuccessful attempt with through-the-scope clips followed by successful closure with sequential OTSCs.</div></div><div><h3>Results</h3><div>Approximation of defect edges with through-the-scope clips was technically challenging because of location and width of the defect. Ultimately, the perforation was closed with 2 OTSCs. A retroflexed examination of the defect with gastroscope found a persistent defect along the posterior aspect. The remaining area was closed with a third OTSC deployed in retroflexion.</div></div><div><h3>Conclusions</h3><div>This case highlights use of sequential OTSCs, including one deployed in retroflexion to successfully close a large, full-thickness transverse colonic perforation following an EMR. We describe modified positioning of the OTSC that enabled more tissue acquisition with clip deployment. The patient did well postprocedurally, without need for surgical intervention.</div></div>\",\"PeriodicalId\":55855,\"journal\":{\"name\":\"VideoGIE\",\"volume\":\"10 10\",\"pages\":\"Pages 544-547\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-10-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"VideoGIE\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2468448125001389\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"VideoGIE","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2468448125001389","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"Medicine","Score":null,"Total":0}

引用次数: 0

摘要

背景和目的内镜下粘膜切除术（EMR）存在医源性结肠穿孔的风险。在这种情况下，我们讨论了使用连续的镜外夹（OTSCs）在内镜下关闭结肠穿孔，其中一个在后伸中部署。方法对61岁横结肠息肉患者进行EMR检查。由于注入举升剂无法提供足够的升力，因此采用热陷阱进行水下EMR。息肉切除术后发现全层穿孔。我们回顾了我们的射孔闭合技术，包括一次不成功的通过范围夹的尝试，以及随后成功的连续OTSCs闭合。结果由于缺陷的位置和宽度的限制，用贯穿范围的夹子逼近缺陷边缘在技术上具有挑战性。最终，用2个OTSCs关闭了射孔。用胃镜对缺损进行后屈检查，发现沿后侧有一个持续的缺损。剩余的区域已关闭，第三个OTSC部署在后方。结论：本病例强调了连续OTSCs的应用，包括在EMR后成功关闭大的全层横结肠穿孔。我们描述了改进的OTSC定位，可以通过夹子部署获得更多的组织。患者术后表现良好，无需手术干预。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Endoscopic closure of full-thickness transverse colon perforation with sequential over-the-scope clips including retroflexed deployment

Background and Aims

Endoscopic mucosal resection (EMR) poses a risk of iatrogenic colonic perforation. In this case, we discuss the endoscopic closure of a colonic perforation with sequential over-the-scope clips (OTSCs), one of which was deployed in retroflexion.

Methods

A 61-year-old patient presented for EMR of a transverse colon polyp. Lifting agent injection provided inadequate lift, so underwater EMR was performed with a hot snare. After en bloc polypectomy, a full-thickness perforation was found. We review our perforation closure technique, including an unsuccessful attempt with through-the-scope clips followed by successful closure with sequential OTSCs.

Results

Approximation of defect edges with through-the-scope clips was technically challenging because of location and width of the defect. Ultimately, the perforation was closed with 2 OTSCs. A retroflexed examination of the defect with gastroscope found a persistent defect along the posterior aspect. The remaining area was closed with a third OTSC deployed in retroflexion.

Conclusions

This case highlights use of sequential OTSCs, including one deployed in retroflexion to successfully close a large, full-thickness transverse colonic perforation following an EMR. We describe modified positioning of the OTSC that enabled more tissue acquisition with clip deployment. The patient did well postprocedurally, without need for surgical intervention.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊

VideoGIE Medicine-Gastroenterology

CiteScore

1.50

自引率

0.00%

发文量

132

审稿时长

105 days

期刊介绍： VideoGIE, an official video journal of the American Society for Gastrointestinal Endoscopy, is an Open Access, online-only journal to serve patients with digestive diseases. VideoGIE publishes original, single-blinded peer-reviewed video case reports and case series of endoscopic procedures used in the study, diagnosis, and treatment of digestive diseases. Videos demonstrate use of endoscopic systems, devices, and techniques; report outcomes of endoscopic interventions; and educate physicians and patients about gastrointestinal endoscopy. VideoGIE serves the educational needs of endoscopists in training as well as advanced endoscopists, endoscopy staff and industry, and patients. VideoGIE brings video commentaries from experts, legends, committees, and leadership of the society. Careful adherence to submission guidelines will avoid unnecessary delays, as incomplete submissions may be returned to the authors before initiation of the peer review process.