Endoscopic closure of small gastrointestinal perforations using endoclips

Background: The improvement of both endoscopic technique and device system made therapeutic endoscopic procedures more clinically available. But the most worrisome complication is perforation. Generally, gastrointestinal(GI) perforation secondary to endoscopic procedures are treated by surgery. The clipping apparatus was originally developed by Hayashi in 1975 to bring about endoscopic hemostasis of bleeding ulcers. The currently available endoscopic metallic clipping has been widely used to mark lesion, ligate esophageal varices and close mucosal defects following endoscopic mucosal resections. Recently Binmoeller et al described closure of a small perforation in stomach using Endoclips [1], however, no additional study has been reported. We evaluate the clinical availability of Endoclips for the management of small GI perforations. Material and Methods: A total 5 patients with GI perforations following endoscopic procedures were included in this study. The diseases of patients are flat adenoma of stomach 1 case, early gastric cancer 1 case, GIST(gastrointestinal stromal tumor) 2 cases and early colon cancer 1 case. Therapeutic endoscopic procedures causing GI perforations were either endoscopic mucosal resection or incisional enucleation. Endoscopy was performed for closing the perforation using metallic clips(MD 850, Olympus Corp.) and clip delivery catheters(HX-3L, HX-5LR-1, Olympus Corp.) Results: Diagnosis Location Age Sex Size (cm) Procedure Result EGC body, post. wall 75 F 2.5 × 1.3 EMR success GIST fundus 59 F 1.3 × 1.2 IE success GIST fundus 56 F 3.3 × 3.0 IE success Flat adenoma body, ant. wall 66 M 2.3 × 1.7 EMR success ECC sig. colon 55 F 2.1 × 1.1 EMR success EMR: endoscopic mucosal resection IE: incisional enucleation No complication secondary to clipping occured. Follow up endoscopy showed complete healing, with scar. Conclusions: Endoclips can be applicated to close small GI perforations and thus may help to avoid surgery.