Closure of esophageal perforation after stricture dilation with novel through-the-scope clip

Perforation during dilation of a refractory stricture can be challenging to manage endoscopically due to the friable nature of the tissue. A dual approximation tissue clip (DAC) is a novel through-the-scope (TTS) closure device designed for endoscopic closure of mucosal defects. There is emerging literature on the use of DACs for closure of resection defects, but there is limited knowledge regarding their efficacy in managing an acute perforation. Here, we describe a patient who had an esophageal perforation after dilation for refractory esophageal stricture and underwent successful endoscopic closure with DACs.

A 61-year-old man with a history of Barrett's esophagus complicated by refractory esophageal stricture was referred to us for dilation. Post-dilation inspection revealed a 1-cm defect in the distal esophagus consistent with esophageal perforation. Using the 2 independently operated jaws of 3 DACs, we approximated the edges of the defect and achieved closure. A stent was placed for secondary reinforcement.

The patient remained hemodynamically stable throughout the procedure and was admitted to the intensive care unit for close monitoring. No adverse events were experienced, and the stent was removed on follow-up endoscopy 6 weeks later with no residual perforation or leak seen.

Endoscopic closure of acute perforation with TTS clips in patients with esophageal strictures is typically challenging due to the friable nature of tissue. The independently operated jaws of the DAC allow for more controlled tissue approximation. This function provided endoscopic closure of esophageal perforation in our case, proving DACs to be a useful addition to the armamentarium of endoscopists.