Endoscopic clips for closing esophageal perforations: case report and pooled analysis

• Published in: Gastrointestinal endoscopy 2007-09, Vol.66 (3), p.605-611
• Main Authors: Qadeer, Mohammed A., MD, Dumot, John A., DO, Vargo, John J., MD, MPH, Lopez, A. Rocio, MS, MPH, Rice, Thomas W., MD
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Chronic Disease; Digestive system. Abdomen; Electrocoagulation; Endoscopy; Esophageal Fistula - surgery; Esophageal Perforation - surgery; Esophagoscopy; Female; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Gastroplasty - adverse effects; Humans; Iatrogenic Disease; Investigative techniques, diagnostic techniques (general aspects); Laparoscopy - adverse effects; Medical sciences; Middle Aged; Recurrence; Reoperation; Stents; Surgical Instruments; Treatment Failure
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2007.03.1028

Background Acute and chronic esophageal perforations have traditionally been treated with surgery or a conservative approach. Recently, endoscopic repair has been reported in some case reports. Objective To describe a case of a chronic esophagoperitoneal fistula successfully closed by endoscopic clips after several failed reoperations and stent placement. To perform a pooled analysis of the reports describing such closures. Design Case report and pooled analysis. Setting Tertiary-care hospitals. Patients Our patient presented with mature perforation in the distal esophagus caused by laparoscopic band gastroplasty. Patients for pooled analysis identified by a MEDLINE search (1966 to January 2007) performed for all the English language articles that reported esophageal perforation/fistulae and endoscopic clips. Interventions Endoscopic clip application after ablation of epithelialized edges in our patient. Pooled analyses for demographic and perforation variables, along with predictors for closure time after clipping, were performed. Main Outcome Measurements Closure of esophageal perforations. Results The fistula in our patient closed in 3 weeks after endoscopic clipping. The literature review identified a total of 11 articles that describe 17 patients (acute 7, intermediate 4, and chronic 6). The most common cause was iatrogenic (65%), and the size of the perforation ranged from 3 to 25 mm. The median healing time after clipping was 18 days (interquartile range 6-26). Both univariable and multivariable analyses identified only the duration of perforation as a significant predictor of closure time, P values .003 and .02, respectively. Limitations Small sample size, nonrandomized sample. Conclusions Endoclips may be effective for closing both acute and chronic esophageal perforations. The duration of the perforation is a significant factor for predicting closure time.