1. Polypectomy Perforation , Clipping
Najaf April 25-26, 2011
Fayez Sandouk MD FRCP
Chairman GI Scientific Council Ministry of Health , Syria
Chairman YCP in AMAGE,
Coordinator OMED/WEO Outreach DVD Program
Damascus – Syria
Master für Startseite

2. Recurrent Rectal Bleeding
Polypectomy
Perforation , Clipping
34 YO Female
Recurrent Rectal Bleeding

3. Polypectomy Perforation , Clipping
Descending Colon
Wide Base

4. Polypectomy Perforation , Clipping
Descending Colon
Injection

5. Polypectomy Perforation , Clipping
Descending Colon
Cut
&
Perforation

6. Polypectomy Perforation , Clipping
Descending Colon
Clipping

7. Polypectomy Perforation , Clipping
Descending Colon
Basket

8. Polypectomy
Perforation , Clipping

9. Polypectomy
Perforation , Clipping

10. Polypectomy Perforation , Clipping
The risk of perforation in Therap. Colo is 2%
Metallic Repair if failed, then for Marking for surgery
Endoscopic closure of large colonic perforations using an over-the-scope clip: a randomized controlled porcine study in porcine models. Germany. von Renteln D, et al Endoscopy Jun;41(6):558-9.
closure with endoluminal clips . Italy . JSLS Jan-Mar;13(1):69-72.
Endoscopic closure of acute iatrogenic perforations during diagnostic and therapeutic endoscopy in the gastrointestinal tract using metallic clips: a literature review.Italy J Dig Dis Feb;11(1):12-8.
2008 Dec;12(4):315-21; discussion 322. Epub 2008 Nov 18.
Digestion. 2008;78(4): Epub 2009 Jan 13.
Surg Endosc Sep;22(9): Epub 2008 Jul 2. Safety & Efficay ?
Gastrointest Endosc Aug;68(2): cm perforation
Am J Gastroenterol Dec;95(12):
Endoscopy Nov;41(11): Netherland: The frequency of perforation was found to be 1 in 1400 for overall colonoscopies and 1 in 1000 for therapeutic colonoscopies. Advanced age, female sex, the presence of multiple co-morbidities, diverticulosis, and bowel obstruction have been shown to increase the risk of perforation. The decision
between surgery and nonoperative treatment will depend on the type of injury, the quality of bowel preparation, the underlying colonic pathology, and the clinical stability of the patient.

11. Clip closure at 1-cm intervals is sufficient for successful closure of a 2-cm colon perforation. USA
Gastrointest Endosc Dec;64(6):
Duration

12. Perforation occurred in 10.4 % of the ESD procedures. japan
Endoscopy Sep;41(9):

13. Surg Endosc. 2008 Jun;22(6):1500-4. Meinhaeim
METHODS: In this series, 7589 colonoscopies were performed over a 34-month period in a tertiary-level referral center. Three perforations occurred during 5413 diagnostic colonoscopies. Therapeutic colonoscopy was under taken in 2176 patients, resulting in a total of 27 perforations. Out of 30 patients with colonic perforation, five patients underwent operative management and 25 patients were subsequently treated nonoperatively.
RESULTS: In 27 patients, endoscopic application of inert metallic clips was used for closure of iatrogenic perforation. Twenty-five of these patients were treated non-operatively, while two patients underwent surgery. The mean postoperative length of hospitalization for patients was 12.2 days, compared to 3.5 days for patients treated conservatively.

14. Endoscopy Nov;41(11): Netherland: The frequency of perforation was found to be 1 in 1400 for overall colonoscopies and 1 in 1000 for therapeutic colonoscopies. Advanced age, female sex, the presence of multiple co-morbidities, diverticulosis, and bowel obstruction have been shown to increase the risk of perforation. The decision between surgery and nonoperative treatment will depend on the type of injury, the quality of bowel preparation, the underlying colonic pathology, and the clinical stability of the patient.

15. Thanks
Fayez