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Endoscopic clips for closing esophageal perforations: case report and pooled analysis
Mohammed A Qadeer1, John A Dumot, John J Vargo
1Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio 44195, USA.
Gastrointestinal Endoscopy
|August 30, 2007
Summary
Endoscopic clips offer an effective minimally invasive treatment for esophageal perforations, including chronic fistulas. Healing time is significantly influenced by the duration of the perforation, with shorter durations predicting faster closure.
Area of Science:
- Gastroenterology
- Minimally Invasive Surgery
- Endoscopy
Background:
- Esophageal perforations, both acute and chronic, traditionally require surgical or conservative management.
- Endoscopic repair has emerged as a less invasive alternative, with case reports demonstrating its feasibility.
Observation:
- A case of a chronic esophagoperitoneal fistula, resistant to multiple reoperations and stent placements, was successfully managed with endoscopic clips.
- A pooled analysis of existing literature was conducted to evaluate the efficacy of endoscopic clips for esophageal perforation closure.
Findings:
- Endoscopic clip closure was successful in the presented case within 3 weeks.
- The literature review identified 17 patients with esophageal perforations (acute, intermediate, and chronic) treated with endoscopic clips.
- The median healing time for esophageal perforations closed with endoscopic clips was 18 days.
- Perforation duration was the only significant predictor of closure time in both univariable and multivariable analyses.
Implications:
- Endoscopic clips represent a viable therapeutic option for a range of esophageal perforations, including complex chronic cases.
- The duration of an esophageal perforation is a critical factor in predicting the success and timing of endoscopic clip closure.
- Further research with larger sample sizes is warranted to solidify these findings.
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Clinical Manifestations:
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