Endoscopic closure of an endoscope-related duodenal perforation using the over-the-scope clip.

Perforations of the duodenum are a significant source of morbidity in clinical practice. Surgical repair is usually mandated, but it is associated with significant morbidity and mortality. Until recently, there has been no technique available which reproducibly and safely allowed endoscopic closures of penetrating defects within the digestive tract. With the new over-the-scope clipping system", which regarding design and function is similar to a bear-trap, the endoscopic closure of perforations has become possible. Here, we report our first experience with the over-the-scope clipping system for the closure of duodenal perforation developed during endoscopic retrograde cholangiopancreatography. A 79-year-old woman with jaundice resulting from obstruction of the common bile duct caused by choledocholithiasis underwent endoscopic retrograde cholangiopancreatography. At the time of the procedure, an endoscope-related perforation measuring about 15 mm was visualized proximal to the papilla. Endoscopic repair was performed by using the over-the-scope clipping according to a standardized operating procedure. Amsterdam type plastic stent was placed into the common bile duct. An abdominal computed tomography with gastrographin showed a pneumoretroperitoneum in the peripancreatic-perirenal area and complete closure of the perforation. The patient remained symptom free, no signs of sepsis developed, and the obstructive jaundice was relieved by endoscopic biliary drainage. The patient was allowed to have a full diet one week later and was discharged from the hospital 2 weeks later. It seems that, the over-the-scope clipping is effective for endoluminal closure of endoscope-related duodenal perforations.