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Create a Free AccountProcedures - Closure of Perforation/Fistula
Successful management of a duodenal perforation using a through-the-scope suturing device after failed attempt at closure with an over-the-scope clip
The X-Tack Endoscopic HeliX Tacking System (Apollo Endosurgery, Austin, Tex, USA) is a novel through-the-scope suture-based device approved for tissue approximation of mucosal defects. Initial case reports and case series have been encouraging on its efficacy for closure of mucosal defects.1-3 However, this device is not intended for full-thickness closure, and there are limited data on this approach.4,5 In this video, we present the successful use of the HeliX Tacking System for the management of a duodenal perforation after a same-session failed attempt at closure with an over-the-scope clip (OTSC).Endoscopic tacking system as a novel tissue approximation measure for very large EMR defects
Defect closure post-EMR and endoscopic submucosal dissection (ESD) is recommended to decrease the risk of delayed bleeding and perforation. Current methods of tissue approximation and closure of mucosal defects have their limitations, including restricted maneuverability, need for scope withdrawal, or difficulty in apposing larger defects. Through-the-scope HeliX tacking system (Apollo Endosurgery, Austin, Tex, USA) is a novel tissue apposition device designed to mimic suture closure without the need to withdraw the endoscope or insert bulky devices on the tip of the endoscope.Persistent gastro-cutaneous fistula closure with tack suture system in the setting of a severe esophageal stricture
A 64-year-old man with a history of metastatic squamous cell carcinoma of the larynx underwent laryngopharyngectomy with good response to adjuvant combination of immunotherapy and chemotherapy. Postoperatively, the patient developed symptomatic esophageal stricture requiring serial sessions of endoscopic dilation, which resulted in improved nutritional status and the removal of a previously placed PEG tube. However, a gastro-cutaneous PEG fistula (GCF) persisted 5 months after PEG tube removal, significantly affecting the patient’s quality of life.Endoscopic through-the-scope suturing
There is growing interest in closure of larger mucosal defects, given the increasing use of endoscopic resection for early GI neoplasia and the advent of submucosal endoscopy, including peroral endoscopic myotomy. Existing closure methods include through-the-scope clips, over-the-scope clips, and over-the-scope suturing. Although over-the-scope clips and over-the-scope suturing allow closure of large defects, both require endoscope removal for device application and may have difficulty in treating lesions in the proximal colon or the small intestine.Prophylactic appendiceal retrograde intraluminal stent placement (PARIS)
EMR or endoscopic submucosal dissection (ESD) are highly effective methods for resecting colonic polyps1-4 but are ineffective when removing polyps arising from the appendiceal orifice. Endoscopic full-thickness resection (EFTR) using the full-thickness resection device (FTRD; Ovesco, Tuebingen, Germany) is a favorable approach for the management of such lesions because it overcomes the potential risk of perforation or incomplete resection by deployment of an over-the-scope clip (OTSC) beneath the polyp before resection.Double-channel double-grasper technique in over-the-scope clip deployment
Endoscopic management of GI fistula and leak is increasingly used. One option is to apply over-the-scope clip (OTSC) devices to close defects.1-4 However, securing 2 opposing walls of a fistula and pulling them into the plastic hood can be challenging. A twin grasper and a tissue anchor are commonly used endoscopic devices to grasp tissue around the defect and pull them into the plastic hood of the OTSC before clip deployment.5 The twin grasper and the tissue anchor both have limitations, especially when the defect is large.Full-thickness resection of subepithelial nodules, allowing for the diagnosis of an unusual case of pneumatosis cystoides intestinalis
A 61-year-old otherwise healthy man was referred to us for further evaluation of multiple firm, large, subepithelial descending colonic nodules. The area of nodularity was found incidentally on a screening colonoscopy and was located in the descending colon near the splenic flexure. The nodules extended over a length of 5 cm and varied in size from 1 cm to 2.5 cm. One nodule was sampled several times; however, examination of biopsy specimens revealed only colonic mucosa with inflammation and architectural distortion.Endoscopic identification and clipping of an anastomotic leak after colorectal surgery by use of methylene blue dye and over-the-scope clipping system
A 56-year-old woman with high-grade serous ovarian carcinoma who had undergone extensive surgical debulking and rectosigmoid and cecal resection with side-to-side anastomosis presented on postoperative day 14 with sepsis in the setting of a pelvic collection (Fig. 1). An ileocecal leak was identified by a sinogram (Fig. 2) performed with the use of pelvic drains placed by the interventional radiology service, suggesting a postsurgical ileocecal anastomotic leak. After multidisciplinary discussions involving the surgery and interventional radiology services, endoscopic intervention was deemed to be the best minimally invasive approach for closure of this anastomotic leak so the patient could proceed with chemotherapy and radiation afterward.
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