A pilot study of endoscopic closure of colonic perforations with endoclips in a swine model

Background

Surgical closure of a colon perforation is accompanied by the risks of general anesthesia and prolonged recovery from surgery because of ileus and other sequelae. Very little is known about the effectiveness of endoluminal repair of colon perforations with clips, which eliminates incisions of the abdominal wall and provides a less invasive alternative to surgical closure. The aim of this study is to evaluate the feasibility and the safety of endoscopic closure of colonic perforations with endoclips in a porcine model.

Methods

Approximately 1.5- to 2-cm colon perforations created with a needle knife in 4 50-kg, female pigs that were under general anesthesia were closed with endoclips. After 24 hours of recovery, the animals were allowed to eat. All the animals received intravenous antibiotics and were carefully monitored for signs of sepsis. After a follow-up of 1 week, the pigs were euthanized for postmortem examination. The fifth pig was euthanized immediately after closure of a 5-cm colon perforation with clips to evaluate the extent of transmural closure with endoclips.

Results

The animals recovered well, without any clinical features of sepsis or peritonitis. Postmortem examination did not reveal fecal peritonitis, and there was no evidence of pericolonic abscess formation at the site of perforation. The perforation site showed signs of healing without any evidence of transmural dehiscence. Histopathology demonstrated granulation tissue bridging the site of perforation. In the fifth pig, euthanized immediately after closure of the perforation, nice mucosal apposition was seen, while the muscular and serosal coats remained dehisced.

Conclusions

Endoscopic closure of small iatrogenic colon perforations with clips results in mucosal and submucosal healing and prevents fecal soiling of peritoneal cavity.