Watch the PADLOCK CLIP Defect Closure System used during an endoscopy closure of a colonoscopy perforation. Below is a description of the case:
*Patient History:*
An 87-year-old woman underwent a surveillance colonoscopy at an outside endoscopy center. The sigmoid colon was narrowed and tortuous, and perforation occurred despite the endoscopist's careful endoscope advancement. This was recognized promptly, and an attempt at closure with through-the-scope clips was made. However, due to the angulated and narrow lumen, closure was not effective. The patient was transferred to our hospital's advanced endoscopy unit the same day. A repeat sigmoidoscopy was done about three hours later. A gastroscope was utilized for better maneuverability in the sigmoid colon. Water filling of the lumen was done to avoid air insufflation into the peritoneum. Two through-the-scope clips could be seen near a minor defect, but the defect was not closed. One of the clips could be seen partially entering the defect and was removed with a grasper before closure with the PADLOCK CLIP Defect Closure System.
*PADLOCK CLIP Defect Closure System use:*
A Padlock Clip device was loaded onto the gastroscope. The endoscope could be advanced to the perforation area, and the single attached through-the-scope clip was centered within the Padlock Clip system tissue chamber. Full suction was applied for a few seconds, and then the Padlock Clip device was deployed. The position of the Padlock Clip device looked good, and the previous hemostatic clip was within the closure area (See fig. 3 & 4). The site was tattooed after applying the Padlock Clip device to assist the surgeon in localizing the site just in case surgery became necessary
*Results:*
Discussion with the colorectal surgeon followed, and he recommended conservative management with hospital admission and intravenous (IV) antibiotics only. A computed tomography (CT) scan was not recommended. The patient did very well and did not develop abdominal pain or signs of peritonitis. She was discharged after a two-day hospitalization and did not require surgery. Immediate identification and closure of iatrogenic colonic perforations that might occur during colonoscopy can allow avoidance of surgery. In this case, through-the-scope clips were inadequate to provide closure. The PADLOCK CLIP System allowed for complete closure and emergency surgery with possible colostomy could be avoided in this elderly patient.
*Conclusion:*
“The PADLOCK CLIP [Defect Closure System] quickly closed a colonoscopic perforation in a tortuous and narrow area of the sigmoid colon, and surgical repair could be avoided” -Dr. David L. Diehl
In the event a perforation of the bowel occurs during a colonoscopy, endoscopic intervention may be necessary to help close the tear. The PADLOCK CLIP Defect Closure System features an over-the-scope hemostatic clip that facilities full tissue closure by encircling, lifting, and closing defects. The PADLOCK CLIP attaches to the outside of the endoscope to allow for an open instrument channel or suction as well as utilization of through-the-scope devices during procedures.
Learn more about the PADLOCK CLIP Defect Closure System or request a quote: [ Ссылка ]
