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Feasibility study of secure closure of gastric fundus perforation using over-the-scope clips in a dog model
Xiu-Li Zhang1, Jian-Hui Qu, Gang Sun
1Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China.
Background And Aim:
Gastric fundus perforation is a serious complication of endoscopic mucosal resection and endoscopic submucosal dissection performed for the removal of early gastric cancers or subepithelial tumors. The novel over-the-scope clip (OTSC) has recently been found to be effective for closing gastrointestinal-tract perforations and accesses for natural orifice transluminal endoscopic surgery. However, feasibility studies of OTSCs in gastric fundus perforation are still lacking. The aim of this study was therefore to demonstrate the feasibility of endoscopic closure of gastric fundus perforation using the OTSC system in a dog model.
Methods:
Gastric fundus perforations were created by needle-knife electrocautery in seven dogs. The perforations were then closed using the OTSC clipping system. Stomach distension was maintained by maximum insufflation with air and methylene blue solution (500 mL) was instilled to submerge the closed perforation. Leaks were detected laparoscopically.
Results:
Perforations were closed in all seven cases with a mean time of 18.5 ± 6.4 min (11-28 min). Twin Grasper assistance failed to release the OTSCs in two of the seven cases (2/7, 28.6%) because of difficulties associated with the J-maneuver (retroflexion of endoscope) required for the gastric fundus procedure, and OTCS were forced into place by suction. Minor leakage was observed in one case (1/7, 14.3%). No damages related to the clip system were found during postmortem examinations.
Conclusions:
Despite difficulties associated with the J-maneuver of the endoscope, this small series demonstrated that sufficient closure of gastric fundus perforation could be achieved using the OTSC system.
Insights
The over-the-scope clip (OTSC) system effectively closed gastric fundus perforations in a dog model. This endoscopic approach shows promise for managing complications from gastric procedures.
Area of Science:
- Gastroenterology
- Endoscopic Surgery
- Surgical Innovation
Background:
- Gastric fundus perforation is a severe complication of endoscopic resections.
- Over-the-scope clips (OTSCs) are effective for gastrointestinal perforations.
- Feasibility of OTSCs for gastric fundus perforation requires investigation.
Purpose of the Study:
- To assess the feasibility of endoscopic closure for gastric fundus perforations.
- To evaluate the over-the-scope clip (OTSC) system in a canine model.
Main Methods:
- Gastric fundus perforations were created using needle-knife electrocautery in seven dogs.
- Perforations were closed endoscopically with the OTSC system.
- Leak detection involved air insufflation, methylene blue instillation, and laparoscopic examination.
Main Results:
- Successful closure of perforations was achieved in all seven dogs (100%).
- Mean closure time was 18.5 ± 6.4 minutes.
- Minor leakage occurred in one case (14.3%); no clip-related damage was observed postmortem.
Conclusions:
- The OTSC system is feasible for closing gastric fundus perforations.
- Despite challenges with the J-maneuver, sufficient closure was demonstrated.
- Endoscopic management of gastric fundus perforations using OTSCs is promising.
