Endoscopic closure of duodenal perforations by using an over-the-scope clip: a randomized, controlled porcine study
Endoscopic closure of duodenal perforations by using an over-the-scope clip: a randomized, controlled porcine study
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DOI：
10.1016/j.gie.2009.07.006
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发表时间：
2010-01-01
影响因子：
7.7
通讯作者：
Caca, Karel
中科院分区：
文献类型：
--
作者：
von Renteln, Daniel;Rudolph, Hans-Ulrich;Caca, Karel
背景：在诊断性上消化道内窥镜检查中，十二指肠穿孔是罕见的；然而，当采用治疗技术时，报告的发生率高达2.8%。目的：比较超范围夹子(OTSC)与外科闭合治疗十二指肠穿孔的疗效。设计：随机对照动物研究动物实验动物：家猪(24只雌性)。干预：使用内窥镜针刀造成较大(10 Mm)的十二指肠穿孔。动物被随机分配到开放手术修补组(n=12)和使用OTSC系统的内窥镜闭合组(n=12)。在解剖过程中进行加压渗漏试验。主要结果测量：在十二指肠切开术中因肝脏损伤发生一次大出血，平均内窥镜关闭时间为5分钟(范围3-8分钟SD+/-2)。所有封闭术过程中均未出现并发症。在尸检中，所有OTSC和手术闭合显示十二指肠切开部位完全封闭。加压渗漏试验显示，OTSC封堵器的平均破裂压力为166 mm Hg(范围80-260；SD+/-65)，外科缝合线的平均破裂压力为143 mm Hg(范围30-300，SD 83)。体外完整的十二指肠标本显示平均破裂压力为2417 mm Hg(范围200-300；SD 35)，显著高于体内OTSC和手术关闭(P<；0.01)。OTSC的破裂压力和手术关闭的压力之间没有显著差异(P=.461)。限制：无存活环境。结论：在无存活的猪模型中，使用OTSC系统进行十二指肠穿孔的内窥镜关闭与手术关闭具有可比性。该技术易于穿孔，适合于十二指肠穿孔修补术。(胃肠内毒素2010；71：131-8)
Background: Duodenal 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.Objective: To compare closure of duodenal perforations by using an over-the-scope clip (OTSC) with a surgical closure.Design: Randomized, controlled animal studySetting: Animal facility laboratory Animals: Domestic pigs (24 Females).Interventions: Large (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 Measurements: One 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 2417 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).Limitations: Nonsurvival Setting.Conclusions: Endoscopic closure of duodenal perforations by Using the OTSC system is comparable with Surgical closure in a nonsurvival porcine model. This technique is easy to perforin and seems suitable for repairing duodenal perforations. (Gastrointest Endosc 2010;71:131-8)