Endoloop-clip closure versus hemoclips for large sigmoid colon perforations: a randomized controlled ex vivo study

Sigmoid colon perforations during colonoscopy are technically challenging to close endoscopically because of fixed angulation and luminal redundancy. This study compared the endoloop-clip technique with conventional hemoclips for the closure of large sigmoid colon perforations.

In this prospective, randomized, controlled ex vivo study, 40 standardized full-thickness 3-cm defects were created in fresh porcine sigmoid colon specimens and randomly assigned (1:1) to hemoclip closure (n = 20) or endoloop-clip closure (n = 20). Two experienced endoscopists each performed 10 closures per group. An independent observer recorded total procedure time, ineffective clip placements, and closure outcomes using air insufflation and underwater leak testing.

Closure was successfully achieved in most cases, with a technical success rate of 95% in both groups. Procedure time was shorter with endoloop-clip than with hemoclips alone (10.8 ± 2.5 vs 14.5 ± 7.3 min; p = 0.044), and ineffective clip placements per case were fewer (0.05 ± 0.22 vs 0.70 ± 0.98; p = 0.009). The mean number of hemoclips used was not significantly different (7.9 ± 1.7 vs 9.1 ± 2.4; p = 0.083). Complete closure by air insufflation and underwater leak testing was achieved in 65% (13/20) vs 50% (10/20) (p = 0.337). Inter-operator differences in procedure time and clip use were observed in the hemoclip group, although these did not reach statistical significance.

In a standardized ex vivo porcine model of a 3-cm sigmoid colon perforation, the endoloop-clip technique reduced procedure time and ineffective clip placement while achieving closure outcomes comparable to those of hemoclips alone.