Metal Endoclips Research Articles

Closure of Appendicular Stump Using Absorbable Polydioxnon Endoclips in Laproscopoic Appendictomy

Background: Since 1983 when the 1st laparoscopic appendectomy was described by Semms, different methods for closure of the appendicular stump during laparoscopic appendectomy such as linear stapler (Endo GIA), endoloop ligature, intracorporeal suture and metal endoclips were used. The use of non-absorbable plastic clips was described in several studies which reported the low cost and easy application of these clips. Objective: to evaluate the efficiency of closure of appendicular stump using polydixanone AP 400 endosclips techniques as regard the intraoperative and postoperative complications. Patients: From October 2014 to October 2015, 40 patients from General surgery department Sohag university hospitals undergoing laparoscopic appendectomy with closure of appendicular stump using polydixanone AP 400 endosclips was done for all the patients. Primary outcome measures: were feasibility of the clip, intra-abdominal surgical site (abscesses, stump leakages) and superficial wound infections. Results: The staples were applicable in nearly 80% of patients. Reasons for not applying the clip were mainly aninflamed caecum or a too large diameter of the appendix base. Superficial wound infections were found in two (5%), intra-abdominal abscesses in one (2.5%), no leak from the appendicular stump was detected. Conclusions: The results suggest that the polydiaxnone endo clip is a safe and effective option in securing the appendicular stump in laparoscopic appendectomy.

Comparison of extra-corporeal knot-tying suture and metallic endo-clips in laparoscopic appendiceal stump closure in uncomplicated acute appendicitis

BackgroundAn adequate closure of the appendiceal stump is vital to minimize intra-abdominal and surgical site infections. There are various techniques for the closure of base of appendix while performing a laparoscopic appendectomy like endoloops, knotting, clips and staplers. ObjectiveTo compare the extracorporeal knot-tying suture with metallic endoclips in laparoscopic appendiceal stump closure in terms of complications, operative time, hospital stay and cost. MethodologyThis study was conducted as a single-blinded randomized controlled trial. Patients undergoing laparoscopic appendicectomies in three tertiary care hospitals of Peshawar, i.e. Khyber Teaching Hospital, Lady Reading Hospital and Hayatabad Medical Complex from June 1, 2013 to June 1, 2014 were included in the study and randomized into two groups – extra-corporeal knotting group and the metallic endoclip group. Data on demographics, complications, operative time, hospital stay and cost for the two techniques were collected and analyzed. Statistics analyses were done with IBM SPSS v19 (IBM Corp., Armonk, NY, USA). T-test was use for comparison of continuous data; Chi-square test was used for comparison of categorical data. P < 0.05 was considered statistically significant. ResultsA total of 68 patients were enrolled in the study and randomized into two groups: metallic endoclip group n = 32 (47.1%), extracorporeal knot group n = 36 (52.9%). The two groups didn't significantly differ in age (P = 0.9). There were no statistically significant differences between the two groups in terms of complication rates (P > 0.05) and hospital stay (P > 0.05). The mean operative time for the endoclip group was shorter (mean 42.1 ± 7.4 min) as compared to the extracorporeal knot group (mean 48.3 ± 8.4 min) (P = 0.002). The cost of endoclip group was higher (800PKR = 8.10US$) as compared to the extracorporeal knot group (220PKR = 2.23US$). ConclusionThe use of metallic endoclip for appendix stump closure is safe and less time consuming but costs higher. Because of the simplicity of the technique it's a useful alternative to the extracorporeal knotting especially for learners.

Combined use of metallic endoclips and endoloops using a single-channel scope in closing iatrogenic perforations and fistulas

Iatrogenic perforation of the gastrointestinal tract is a rare complication of endoscopic procedures, whereas anastomotic leakage after surgery is not uncommon. Both conditions are associated with gut wall defects leading to significant morbidity and mortality of the patients. We describe two case reports, a colonic perforation and an esophagogastric anastomosis leakage successfully managed endoscopically using the combined technique with endoclips and endoloops. A literature review is performed on similar endoscopic techniques aiming to avoid surgical treatment in these patients.

Iatrogenic Duodenal Perforation Treated with Endoscopic Placement of Metallic Clips: A Case Report

Perforation is one of the major complications encountered during endoscopic procedures. The standard of care for these complications is either surgical intervention or nonoperative medical approach with antibiotics and bowel rest with or without parenteral alimentation. Metallic clips, initially developed to secure hemostasis in bleeding, have been successfully used to close perforations in the gastrointestinal tract (GI) including the duodenum. This avoids perioperative morbidities associated with surgical intervention while limiting the leakage of intestinal contents and peritoneal contamination that is possible with medical management. We present a case of a patient with a lateral duodenal perforation during an endoscopic retrograde cholangiopancreatography (ERCP) which was successfully treated with immediate placement of metallic endoclips.

Metal endoclips for the closure of the appendiceal stump in laparoscopic appendectomy

Closure of the appendiceal stump in laparoscopic appendectomy is the most crucial part of the procedure. In this retrospective clinical study, we describe a technique for laparoscopic appendectomy, in which the appendiceal stump is secured by metal endoclips. Medical data of the patients who underwent laparoscopic appendectomy for acute appendicitis between January 2005 and January 2011 at our institution were reviewed. The patients who had their appendiceal stump secured by metal endoclips were recruited for the study. The outcome measures were the rate of intraoperative and postoperative complications, operative time, and the length of hospital stay. A total of 233 patients were included to the study. The rate of intraoperative and postoperative complications, the mean operative time, and median length of hospital stay were 3 and 4%, 31.1 (15-75) min, and 18 (8-96) h, respectively. The closure of the appendiceal stump with metal endoclips in laparoscopic appendectomy is simple, quick, and safe with outcomes comparable to those of other methods.

Endoscopic submucosal dissection for treatment of esophageal submucosal tumors originating from the muscularis propria layer

The technique of endoscopic submucosal dissection (ESD), which was developed for en bloc resection of large lesions in the stomach, has been widely accepted for the treatment of early gastric cancer. It is being used for muscularis propria tumors of the digestive tract and has produced positive therapeutic effects. To study the feasibility of ESD for the removal of esophageal muscularis propria tumors and to evaluate the efficacy and safety of ESD for this treatment. Single-center, retrospective study. University hospital. Thirty esophageal muscularis propria tumors from 28 patients were treated with ESD between December 2008 and December 2010. We defined esophageal muscularis propria tumors as esophageal submucosal tumors originating from the muscularis propria layer. ESD. Tumor characteristics, complications, en bloc resection rate, and local recurrence rate were evaluated. Among the 28 patients, 11 were women (39.3%). The median age was 49.32 years (range 22-62 years). Mean (± SD) tumor size was 1.25 ± 0.70 cm (range 0.5-3.0 cm). Except for 2 failed cases (one changed to surgery and the other changed to nylon ligation), 26 cases with 28 tumors (2 cases had 2 tumors) originating from the muscularis propria of the esophagus were successfully resected by ESD. The en bloc resection rate was 93.3% (28/30). The median ESD procedure time was 73.5 minutes (range 30-120 minutes). Perforation occurred in 2 cases during dissection of the lesion, which was closed with metal endoclips. Pneumothorax occurred after the treatment in both cases. Closed thoracic drainages were initiated, and the patients recovered quickly without surgery. Pathological examination confirmed 27 leiomyomas and 1 GI stromal tumor. The curative resection rate was 100% (28/28). There was no recurrence during a 3 to 27-month follow-up period. The limitation of the study was its retrospective design. ESD offers the promise of localized treatment of esophageal muscularis propria tumors with relatively few complications and low mortality. It makes the resection of whole lesions possible and provides precise histologic information.

Recurrent advanced colonic cancer occurring 11 years after initial endoscopic piecemeal resection: a case report

BackgroundThe high frequency of local recurrence occurring after endoscopic piecemeal resection (EPMR) for large colorectal tumors is a serious problem. However, almost all of these cases of local recurrence can be detected within 1 year and cured by additional endoscopic resection. We report a rare case of recurrent advanced colonic cancer diagnosed 11 years after initial EPMR treatment.Case presentationA 65-year-old male was diagnosed with a sigmoid colon lesion following a routine health check-up. Total colonoscopy revealed a 12 mm type 0-Is lesion in the sigmoid colon, which was diagnosed as an adenoma or intramucosal cancer and treated by EPMR in 1996. The post-resection defect was closed completely using metallic endoclips to avoid delayed bleeding. In 2007, at the third follow up, colonoscopy revealed a 20 mm submucosal tumor (SMT) like recurrence at the site of the previous EPMR. The recurrent lesion was treated by laparoscopic assisted sigmoidectomy with lymph node dissection.ConclusionWhen it is difficult to evaluate the depth and margins of resected tumors following EPMR, it is important that the defect is not closed in order to avoid tumor implantation, missing residual lesions and to enable earlier detection of recurrence. It is crucial that the optimal follow-up protocol for EPMR cases is clarified, particularly how often and for how long they should be followed.

Emergency catheter probe endoscopic sonography (CP-EUS): An effective procedure in the assessment of a bleeding gangliocytic paraganglioma

Catheter probe endoscopic sonography is a relatively rapid and safe procedure, carried out during standard endoscopy, capable of distinguishing solid from cystic lesions and vascular from avascular masses. Herein we discuss the role of catheter probe endoscopic sonography in the emergency assessment of a patient with recent and severe bleeding from an ulcerated polyp, arising from the papilla. During the endoscopy, catheter probe endoscopic sonography showed the solid and submucosal nature of the lesion, suggesting its localised and benign nature and, most importantly, demonstrating the high risk of rebleeding from vascular structures communicating with the ulcer. Because of this finding three metallic endoclips were positioned. The lesion was not removed endoscopically because of its difficult position and the high risk of haemorrhage. The mass, removed through a duodenotomy, was shown to be a gangliocytic paraganglioma, an uncommon tumour, frequently resulting in surgery because of abdominal pain and gastrointestinal bleeding.

A Novel Use of Endoscopic Clips in the Treatment Planning for Radiation Therapy (XRT) of Esophageal Cancer

To determine if the placement of metal endoclips improves radiotherapy (XRT) planning for esophageal cancer. XRT is an important modality in the treatment and palliation of esophageal cancer. Accurate simulation of the radiation field ensures optimal therapy while limiting toxicity. Patients with esophageal carcinoma underwent EGD and endoscopic mucosal clip placement at the proximal and distal margins of the tumor. At XRT simulation the radiation oncologist simulated the field based on barium study, CT scan, and endoscopy report. A second radiation oncologist then assessed the ease of identification of the clips/margins of the tumor, shift in the field isocenter, and change in the radiation field width and length because of the metal clips. Seven patients with cancer of the esophagus had endoscopic clips placed followed by XRT simulation. The clips could be identified in all 7 patients. Simulation with the use of clips caused a shift in the field isocenter with a mean longitudinal shift (y-axis) of 3.5 cm (range, 1-6 cm) and a mean lateral shift (x-axis) of 0.33 cm (range, 0-1 cm). Endoscopically placed mucosal metal clips can aid field simulation when planning radiation therapy in patients with esophageal cancer.

Endoscopic clipping of anastomotic leakages in esophagogastric surgery.

Anastomotic leakage is a severe complication in gastric surgery and it is associated with a high rate of mortality. Conservative treatment sometimes is not sufficient to stem the leakages and, even when it is sufficient, it takes a long time. The present study describes the first experience in the treatment of anastomotic leakages with endoscopic clipping. From May 1995 to December 1996, seven patients with postoperative anastomotic leakages after gastric surgery were prospectively treated in our Endoscopy Service. Metallic endoclips (MD 850, Olympus Corp., Tokyo, Japan) with prongs 12 mm long and 6 mm wide were applied, controlling the closure of the leakage by endoscopy, using radiographs to confirm the closure 24 hours later. Complete closure of the leakage was obtained in all seven cases. A single session of endoscopic clipping was needed for five patients while two other required, respectively, two and three sessions. The median time of leakage closure after endoscopic clipping was 2.3 days (range 1-5 days). The clips spontaneously dislodged within 1 month in five patients and within the second month in the other two patients. Endoscopic treatment of anastomotic leakages by metallic clips represents a safe and easily repeated method and, compared to conservative treatment, it seems to offer several time and cost advantages. Further studies involving a larger number of patients are needed to verify this finding.