Medical Center for Digestive Diseases, The Second Affiliated Hospital, Nanjing Medical University, Nanjing, China.
Department of Gastroenterology, General Hospital of XuZhou Mining Group, Xuzhou, China.
Surg Endosc. 2019 Apr;33(4):1319-1325. doi: 10.1007/s00464-018-6586-1. Epub 2018 Nov 20.
Serious complications due to perforation restrict the development of duodenal endoscopic treatment. The key stage for remediation is the successful endoscopic closure to prevent peritonitis and the need for surgical intervention. This report aimed to present a new simple method for the closure of large iatrogenic duodenal perforations with purse-string sutures using the novel endoloops and repositionable clips through a single-channel endoscope.
A total of 23 patients with iatrogenic duodenal perforations ≥ 1 cm were retrospectively studied who were presently treated by purse-string sutures using the novel endoloops and the repositionable hemostasis clips with the single-channel endoscope at four institutes. During and after the procedure, a 20-gauge needle was used to relieve the pneumoperitoneum or subcutaneous emphysema. Finally, a gastroduodenal decompression tube was placed.
The median maximum diameter of iatrogenic duodenal perforations was 1.65 cm (range 1.0-3.0 cm). Complete endoscopic closure of all 23 perforations was achieved. No patient had severe complications such as peritonitis. The wounds were healed and no obvious duodenal stricture was observed in all cases after 3 months.
Purse-string sutures using the novel endoloops and repositionable endoclips through single-channel endoscope were feasible, effective and easy methods for the closure of large duodenal iatrogenic perforations.
穿孔引起的严重并发症限制了十二指肠内镜治疗的发展。修复的关键阶段是成功的内镜封闭，以防止腹膜炎和需要手术干预。本报告旨在介绍一种新的简单方法，通过单通道内镜使用新型的可重定位套圈和止血夹对大的医源性十二指肠穿孔进行荷包缝合。
回顾性研究了四家机构采用新型可重定位套圈和止血夹通过单通道内镜对 23 例直径≥1cm 的医源性十二指肠穿孔患者进行荷包缝合。在手术过程中和手术后，使用 20 号针头缓解气腹或皮下气肿。最后，放置胃十二指肠减压管。
医源性十二指肠穿孔的最大直径中位数为 1.65cm（范围 1.0-3.0cm）。所有 23 例穿孔均完全内镜封闭。无患者出现腹膜炎等严重并发症。所有患者在 3 个月后伤口愈合，无明显十二指肠狭窄。
通过单通道内镜使用新型可重定位套圈和止血夹进行荷包缝合是一种可行、有效、简单的方法，可用于封闭大的医源性十二指肠穿孔。
