Lee Tae Hoon, Han Joung-Ho, Jung Yunho, Lee Suck-Ho, Kim Dae Hoon, Shin Ji Yun, Lee Tae Soo, Kim Myunghwan, Choi Seok-Hwa, Kim Hyun, Park Seonmee, Youn Seijin
Internal Medicine, Soon Chun Hyang University College of Medicine, Cheonan Hospital, Cheonan, South Korea.
Dig Endosc. 2014 Sep;26(5):659-64. doi: 10.1111/den.12266. Epub 2014 Mar 31.
Recent reports have indicated several instances of successful treatment of bowel perforation by using endoscopic band ligation (EBL) when treatment with endoclipping is unsuccessful, but this salvage method has not been investigated in any prospective model. Herein we aimed to compare the technical feasibility and efficacy of EBL and endoclip use in intraluminal closure of colon perforation, in an ex vivo model.
Standardized colonic perforations were created using fresh porcine colon and subsequently closed by full-thickness interrupted sutures, endoclip (QuickClip2(TM)), or EBL. Each closure site was tested with compressed air by using a digital pressure monitor for evaluating leak pressure.
No significant differences were noted between the endoclip and EBL in leak pressures. Mean (± SD) pressures for air leakage from the perforations closed using the different devices were as follows: normal colon samples, 52.0 ± 13.2 mmHg; perforations closed with hand-sewn sutures, 32.3 ± 8.3 mmHg; perforations closed with endoclipping, 53.5 ± 22.7 mmHg; and perforations closed with EBL, 50.4 ± 12.5 mmHg. Time taken for closure by EBL was significantly less than that for closure by endoclipping (3.2 ± 1.7 min vs 6.8 ± 1.3 min, P < 0.01). Further, the number of devices used to achieve complete closure in the EBL group was lower than that with endoclipping (1.6 ± 0.5 vs 3.7 ± 0.8, P < 0.01).
Endoluminal closure of a 1.5-cm colon perforation with EBL decreased procedure time and was not inferior in leak pressure compared with endoclipping in this ex vivo porcine model.
最近的报告显示，在使用内镜夹闭治疗失败时，使用内镜下套扎术（EBL）成功治疗肠穿孔的案例有几例，但这种挽救方法尚未在任何前瞻性模型中进行研究。在此，我们旨在比较EBL和内镜夹在离体模型中用于结肠穿孔腔内闭合的技术可行性和疗效。
使用新鲜猪结肠制作标准化的结肠穿孔，随后通过全层间断缝合、内镜夹（QuickClip2™）或EBL进行闭合。使用数字压力监测器对每个闭合部位进行压缩空气测试，以评估渗漏压力。
内镜夹和EBL在渗漏压力方面无显著差异。使用不同装置闭合穿孔的平均（±标准差）漏气压力如下：正常结肠样本，52.0±13.2 mmHg；手工缝合闭合的穿孔，32.3±8.3 mmHg；内镜夹闭闭合的穿孔，53.5±22.7 mmHg；EBL闭合的穿孔，50.4±12.5 mmHg。EBL闭合所需时间明显少于内镜夹闭（3.2±1.7分钟对6.8±1.3分钟，P<0.01）。此外，EBL组实现完全闭合所用装置的数量低于内镜夹闭组（1.6±0.5对3.7±0.8，P<0.01）。
在这个离体猪模型中，用EBL进行1.5厘米结肠穿孔的腔内闭合可缩短手术时间，且在渗漏压力方面不逊色于内镜夹闭。
