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Endoluminal Management Of Colon Perforations During Advanced Endoscopic Procedures
*Ilker Ozgur1, *Stefan D. Holubar1, *Amitt Bhatt2, *Scott R. Steele1, Emre Gorgun1
1Cleveland Clinic, Digestive Disease and Surgery Institute, Department of Colorectal Surgery, Cleveland, OH;2Cleveland Clinic, Digestive Disease and Surgery Institute, Department of Gastroenterology and Hepatology, Cleveland, OH

OBJECTIVE Endoluminal surgery is becoming the preferred resection technique for neoplastic colorectal lesions worldwide, as it is less invasive, has low complication rates, and promises organ preservation compared to surgery. Surgeons' adaptation of the technique to the daily clinical practice is still dawdling due to the long learning curve, dexterity, and feared complications. This study presents our clinical experience with interprocedural intraperitoneal perforations managed by endoluminal approaches.METHODS A retrospective review was performed of a prospectively collected database of all patients who underwent endoluminal surgery between 2011 and 2021 at Cleveland Clinic. We included patients with immediate perforation treated with endoscopic clipping and reported treatment modality, outcomes, and final pathology.RESULTS There were 22 (2.2%) immediate intraperitoneal perforations treated with endoscopic clipping out of 1005 resected polyps. The median patient age was 63.5 (IQR 57-71), 50% were female. Most of the procedures were in the operating room (n=14, 64%). Sixteen (73%) resections were proximal to splenic flexure, and median polyp size was 35.8 (20-55) mm. The defect was closed with endoscopic clips in 18 (82%) patients, and four defects were closed with over-the-scope clips. Median hospital stay was 0.8 (0-4) days, and 13 patients were discharged after the
procedure. Patients started liquid diet within 4 hours of procedure. Two patients presented to emergency department and were re-admitted same day. They underwent subsequent laparoscopic suture repair. None of the patients required surgical resection, and there was no late complication within 30 days. Pathology revealed 9 (41%) tubular adenoma, 7 (32%) tubulovillous adenoma, 6 (27 %) sessile serrated lesions, and no adenocarcinoma. There was no recurrence during the median follow-up of 24 months (range: 0-90 months).CONCLUSION Immediate perforations may be treated with endoscopic clipping and no need for immediate surgery.


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