Endoscopic closure of duodenal perforations by using an over-the-scope clip: a randomized, controlled porcine study

BackgroundDuodenal perforations during diagnostic upper endoscopy are rare; however, when therapeutic techniques are performed, the reported incidence is as great as 2.8%. Surgical repair is usually mandated, but it is associated with significant morbidity and mortality.ObjectiveTo compare closure of duodenal perforations by using an over-the-scope clip (OTSC) with a surgical closure.DesignRandomized, controlled animal study.SettingAnimal facility laboratory.AnimalsDomestic pigs (24 females).InterventionsLarge (10-mm) duodenal perforations were created by using an endoscopic needle-knife. The animals were randomly assigned to either open surgical repair (n=12) or endoscopic closure by using the OTSC system (n=12). Pressurized leak tests were performed during necropsy.Main Outcome MeasurementsOne major bleed occurred because of a liver injury during creation of the duodenotomy. Mean time for endoscopic closure was 5 minutes (range, 3-8 min; SD ± 2). No complications occurred during any of the closure procedures. At necropsy, all OTSC and surgical closures demonstrated complete sealing of duodenotomy sites. Pressurized leak tests demonstrated a mean burst pressure of 166 mm Hg (range, 80-260; SD ± 65) for OTSC closures and 143 mm Hg (range, 30-300, SD ± 83) for surgical sutures. Ex vivo intact duodenal specimens exhibited a mean burst pressure of 247 mm Hg (range, 200-300; SD ± 35), which was significantly higher compared with in vivo OTSC and surgical closures (P < .01). There were no significant differences between burst pressures of OTSC and surgical closures (P= .461).LimitationsNonsurvival setting.ConclusionsEndoscopic closure of duodenal perforations by using the OTSC system is comparable with surgical closure in a nonsurvival porcine model. This technique is easy to perform and seems suitable for repairing duodenal perforations.