Clin Endosc.  2015 Nov;48(6):534-541. 10.5946/ce.2015.48.6.534.

Endoluminal Closure of Colon Perforation with Endoscopic Band Ligation: Technical Feasibility and Safety in an In Vivo Canine Model

• Han JH
• Kim M
• Lee TH
• Kim H
• Jung Y
• Park SM
• Chae H
• Youn S
• Shin JY
• Lee IK
• Lee TS
• Choi SH

• KMID: 2380412
• DOI: http://doi.org/10.5946/ce.2015.48.6.534

Abstract

BACKGROUND/AIMS
Endoscopic band ligation (EBL) is an accepted method in the management of variceal bleeding; however, there is little evidence on the safety and feasibility of EBL for the closure of bowel perforation. In this study, we aimed to evaluate the technical feasibility and efficacy of EBL in iatrogenic colon perforation by using a canine model.
METHODS
We established an iatrogenic colon perforation model by using seven beagle dogs. Longitudinal 1.5- to 1.7-cm colon perforations were created with a needle knife and an insulated-tip knife, and the perforation was subsequently closed with EBL. During a 2-week follow-up period, the animals were carefully monitored and then euthanized for pathologic examination.
RESULTS
The EBL of iatrogenic colon perforations was successful in all dogs. The mean procedure time for EBL closure with one to three bands was 191.7 seconds, and there were no immediate complications. One animal was euthanized after 3 days because of peritonitis. There were no clinical and laboratory features of sepsis or peritonitis in the remaining six animals. On necropsy, we did not find any fecal peritonitis, pericolonic abscess formation, or transmural dehiscence at the perforation site. Histopathology demonstrated inflamed granulation tissue and scar lesions replaced by fibrosis.
CONCLUSIONS
EBL might be a feasible and safe method for the management of iatrogenic colon perforations in an in vivo model.

Keyword

Colon perforation; Endoscopic band ligation; Complication

MeSH Terms

Abscess
Animals
Cicatrix
Colon*
Dogs
Esophageal and Gastric Varices
Fibrosis
Follow-Up Studies
Granulation Tissue
Ligation*
Needles
Peritonitis
Sepsis

Figure

• 

  Fig. 1. An iatrogenic 1.5-cm colon perforation model. (A) A small perforation is made with a needle knife, and (B) is widened longitudinally by using an insulated-tip knife until the cap-fitted endoscope could easily pass into the peritoneal cavity.

• 

  Fig. 2. (A) A full-thickness incision is made with an endoscopic knife to the colon in the iatrogenic model. (B) Endoscopic band ligation is used to make a mushroom-like banded mucosa to complete the closure. (C) A band ligates the perforation hole incompletely, although it reduces the size of the hole in a zipper-like fashion. (D) Additional band ligation closes the perforation completely.

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  Fig. 3. Macroscopic view of a necropsy. (A) An external view of the perforation site shows local adhesion with a fibrous band and distant adhesion with the small bowel. (B) An internal view of the perforation site shows an ulcer at the healing stage and (C) a completely healed scar.

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  Fig. 4. Microscopic finding of the healed site of endoscopic band ligation. (A) Complete reepithelialization of the mucosa is seen (arrow). Inflamed granulation tissue remains in the submucosa and serosa (arrowheads) (H&E stain, ×10). (B) Defects of the muscularis propria (arrowheads indicate preexisting smooth muscle bundles) are replaced by fibrosis (arrows) (H&E stain, ×10). (C) The fibrotic adhesion with the small bowel is seen at the site of healing of the perforation on the serosal surface (H&E stain, ×1). (D) Severe fibrosis with chronic inflammation is observed in the pericolic fat tissue (H&E stain, ×40).

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