Abstract
Objective Diagnostic colonoscopy is important for diagnosing colorectal diseases, including inflammatory bowel disease and colorectal tumours. Perforation during diagnostic colonoscopy, a rare but serious complication, is a considerable factor before performing the procedure. Immediate endoluminal closure of a perforation could prevent the adverse consequences associated with general anaesthesia and surgery. This study is aimed at assessing the potential effectiveness and safety of endoscopic band ligation (EBL) in closing a colon perforation during endoscopy in a porcine model. Methods Colon perforations were created and then subsequently closed with EBL in six porcine models. After 28 days of careful follow-up, pigs were euthanized for clinical and pathologic evaluations. Results All colon perforations were successfully closed using EBL in pigs. The mean time of perforation closure with EBL was 244.3 seconds with one to two bands, and there were no immediate complications or clinical manifestations of peritonitis or sepsis in any animals. No pericolonic abscess or peritonitis was found during necropsy. Histopathology demonstrated reepithelialization of the mucosa at the perforation site. Conclusions Immediate closure of perforations caused during colonoscopy with EBL is feasible and safe in a porcine model.
Highlights
Diagnostic colonoscopy is considered to be a first choice tool for diagnosing colorectal diseases in many countries worldwide, as supported by the accumulated evidence of the efficacy of diagnosing colorectal diseases early, leading to reduced mortality, especially for colorectal cancer [1]
Reports have shown that the incidence rate of perforation is 0.03–0.8% during diagnostic colonoscopy [11]
Surgical closure through laparotomy or laparoscopy is an effective management for perforation, there is a risk of complications, such as anaesthetic accident, infection, and ileus [12]
Summary
Diagnostic colonoscopy is considered to be a first choice tool for diagnosing colorectal diseases in many countries worldwide, as supported by the accumulated evidence of the efficacy of diagnosing colorectal diseases early, leading to reduced mortality, especially for colorectal cancer [1]. Iatrogenic colonic perforation during diagnostic colonoscopy is a potentially life-threatening and devastating adverse event that requires emergency management and can cause considerable unexpected hospitalizations and even death in healthy people [2]. A variety of techniques have been reported for endoluminal closing of perforations during colonoscopy. It is recommended that through-the-scope (TTS) clips be used for endoluminal closure of small perforations. Over-the-scope clips (OTSCs) are recommended for larger colonic perforations (>10 mm) as the first choice in specific cases, their high cost limits their utility in developing countries. Gastrointestinal perforations, including perforations formed in the stomach, duodenum, and colon, have been closed by EBL, with a very high success rate in vivo and in some clinical cases [8, 9]
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