Loon Erica, Wilson Natalie, Bilal Mohammad
Department of Internal Medicine, University of Minnesota Medical Center, Minneapolis, Minnesota, USA.
Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota Medical Center, Minneapolis, Minnesota, USA.
VideoGIE. 2025 Mar 5;10(7):337-339. doi: 10.1016/j.vgie.2025.02.011. eCollection 2025 Jul.
Perforation during dilation of a refractory stricture can be challenging to manage endoscopically due to the friable nature of the tissue. A dual approximation tissue clip (DAC) is a novel through-the-scope (TTS) closure device designed for endoscopic closure of mucosal defects. There is emerging literature on the use of DACs for closure of resection defects, but there is limited knowledge regarding their efficacy in managing an acute perforation. Here, we describe a patient who had an esophageal perforation after dilation for refractory esophageal stricture and underwent successful endoscopic closure with DACs.
A 61-year-old man with a history of Barrett's esophagus complicated by refractory esophageal stricture was referred to us for dilation. Post-dilation inspection revealed a 1-cm defect in the distal esophagus consistent with esophageal perforation. Using the 2 independently operated jaws of 3 DACs, we approximated the edges of the defect and achieved closure. A stent was placed for secondary reinforcement.
The patient remained hemodynamically stable throughout the procedure and was admitted to the intensive care unit for close monitoring. No adverse events were experienced, and the stent was removed on follow-up endoscopy 6 weeks later with no residual perforation or leak seen.
Endoscopic closure of acute perforation with TTS clips in patients with esophageal strictures is typically challenging due to the friable nature of tissue. The independently operated jaws of the DAC allow for more controlled tissue approximation. This function provided endoscopic closure of esophageal perforation in our case, proving DACs to be a useful addition to the armamentarium of endoscopists.
由于组织质地脆弱，难治性狭窄扩张过程中发生的穿孔在内镜下处理具有挑战性。双近似组织夹（DAC）是一种新型的经内镜（TTS）闭合装置，设计用于内镜下闭合黏膜缺损。关于使用DAC闭合切除缺损的文献不断涌现，但对于其处理急性穿孔的疗效了解有限。在此，我们描述一名因难治性食管狭窄扩张后发生食管穿孔并通过DAC成功进行内镜闭合的患者。
一名61岁男性，有巴雷特食管病史并伴有难治性食管狭窄，前来我们处进行扩张治疗。扩张后检查发现食管远端有一个1厘米的缺损，符合食管穿孔。我们使用3个DAC的2个独立操作钳口，将近似缺损边缘并实现闭合。放置了一个支架进行二次加固。
患者在整个手术过程中血流动力学保持稳定，并被收入重症监护病房进行密切监测。未发生不良事件，6周后随访内镜检查时取出支架，未见残留穿孔或渗漏。
由于组织质地脆弱，内镜下用TTS夹闭合食管狭窄患者的急性穿孔通常具有挑战性。DAC的独立操作钳口可实现更可控的组织近似。在我们的病例中，这一功能实现了食管穿孔的内镜闭合，证明DAC是内镜医生工具库中的一项有用补充。
