Department of Gastroenterology, Dr. D Y Patil Medical College and Hospital, Pimpri, Pune, 411 018, India.
Department of Gastroenterology, G B Pant Institute of Postgraduate Medical Education and Research, 1, J L N Marg, New Delhi, 110 002, India.
Indian J Gastroenterol. 2021 Jun;40(3):287-294. doi: 10.1007/s12664-021-01152-0. Epub 2021 May 11.
Scope-induced duodenal perforation is a life-threatening complication and surgery remains the standard of care. With the advent of over-the-scope clip (OTSC), scope-induced perforations are increasingly managed conservatively, though there is no study comparing this form of non-surgical treatment with surgery. We aimed to compare OTSC and surgery in the management of scope-induced perforation of the duodenum.
We retrospectively collected data of scope-induced duodenal perforation patients. Perforations identified and treated within 24 h of procedure were analyzed. Factors analyzed were spectrum, etiology, baseline parameters, perforation size, outcome, comorbidities, and duration of hospital stay.
A total of 25 patients had type I duodenal perforations, out of whom five were excluded due to delayed diagnosis and treatment. Of the twenty, eight were treated with OTSC placement while the rest underwent surgery. Age was comparable and the majority were females. Baseline parameters and comorbidities were similar in both the groups. The median size of perforation was 1.5 cm in both the OTSC group and the surgical group. All patients were treated with standard of care according to institutional protocols. Patients in the OTSC group were started orally after 48 h of OTSC placement, while in the surgery group median time to oral intake was 7 days. Two patients in the surgical group died while there was no mortality in the OTSC group (p = 0.48). Median hospital stay was shorter in the OTSC group (2 days vs. 22 days, p = 0.003).
OTSC is a feasible and better option in type I duodenal perforations with a shorter hospital stay.
内镜下操作所致十二指肠穿孔是一种危及生命的并发症，手术仍然是标准的治疗方法。随着内镜下夹闭器（OTSC）的出现，内镜下操作所致穿孔越来越多地采用保守治疗，尽管尚无研究比较这种非手术治疗与手术治疗。我们旨在比较 OTSC 和手术治疗内镜下操作所致十二指肠穿孔的效果。
我们回顾性收集了内镜下操作所致十二指肠穿孔患者的数据。对在操作后 24 小时内发现和治疗的穿孔进行分析。分析的因素包括范围、病因、基线参数、穿孔大小、结果、合并症和住院时间。
共有 25 例患者发生了 I 型十二指肠穿孔，其中 5 例因诊断和治疗延迟而被排除。在这 20 例患者中，有 28 例接受了 OTSC 放置治疗，其余接受了手术治疗。两组患者的年龄相当，大多数为女性。两组患者的基线参数和合并症相似。OTSC 组和手术组的穿孔中位数大小均为 1.5cm。所有患者均根据机构方案接受了标准治疗。OTSC 组患者在放置 OTSC 后 48 小时开始口服饮食，而手术组患者的中位口服饮食时间为 7 天。手术组有 2 例患者死亡，而 OTSC 组无死亡病例（p = 0.48）。OTSC 组的中位住院时间较短（2 天 vs. 22 天，p = 0.003）。
OTSC 是 I 型十二指肠穿孔的一种可行且更好的选择，可缩短住院时间。
