Endoscopic closure of large colonic perforations using an over-the-scope clip: a randomized controlled porcine study

Background and study aims: Perforation of the colon is considered to be one of the most serious complications of flexible endoscopy. The over-the-scope clip system (OTSC) has previously been shown to close small colonic perforations effectively. The aim of this randomized controlled porcine study was to compare acute closure strengths between the novel 11-mm over-the-scope-clip and surgical closure for large colonic perforations. Material and methods: In 24 anesthetized domestic pigs, an 18-mm sigmoid perforation was created endoscopically using a needle knife and dilating balloon. The animals were randomly assigned to undergo either open surgical repair (n = 12) or endoscopic Closure using the OTSC system (n = 12). Pressurized leak tests were performed during necropsy. Results: Mean time to perform the incision in the sigmoid colon and obtain peritoneal access was 5.5 minutes (range 3 - 12; SD +/- 2.5). Mean time for endoscopic-closure was 6.8 minutes (range 3 - 14; SD +/- 3). At necropsy, all OTSC and surgical closures demonstrated complete sealing of colotomy sites. In one case peritoneum and in a second case adjacent small intestine were found incorporated into the OTSC closure. No other complications occurred. Pressurized leak tests revealed a mean burst pressure of 62.8 mmHg (range 18 - 112; SD 35.7) for OTSC closures and 67.4 mmHg (range 30 - 90; SD 19) for sutured closure. No significant differences in burst pressures were noted between the OTSC Closures and surgical repair. Conclusion: Closure of acute perforations using the OTSC system is comparable to surgical closure in a nonsurvival porcine model.