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HOME > Clin Endosc > Volume 57(6); 2024 > Article
Video of Issue Successful iatrogenic duodenal perforation treatment with endoscopic hand suturing
Michał Spychalski1orcid, Michał Łabęcki2orcid, Matylda Sobczak3orcid, Agnieszka Nawrocka-Kunecka4orcid, Przemysław Piotr Kasprzyk1,orcid
Clinical Endoscopy 2024;57(6):832-833.
DOI: https://doi.org/10.5946/ce.2024.117
Published online: July 24, 2024

1Endoscopy and Bariatric Surgery Center, Brzeziny Specialist Hospital, Brzeziny, Poland

2Department of General Surgery, Brzeziny Specialist Hospital, Brzeziny, Poland

3Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland

4Histopathological Department, Consilio Diagnostics, Lodz, Poland

Correspondence: Przemysław Piotr Kasprzyk Endoscopy and Bariatric Surgery Center, Brzeziny Specialist Hospital, Marii Sklodowskiej-Curie 6, 95-060 Brzeziny, Poland E-mail: kasprzykprzemek@gmail.com
• Received: May 9, 2024   • Revised: June 12, 2024   • Accepted: June 13, 2024

© 2024 Korean Society of Gastrointestinal Endoscopy

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Endoscopic treatment of neoplastic lesions in the duodenum carries a significant risk of perforation, a serious adverse event that may require surgical treatment.1 This study describes the successful endoscopic treatment of an iatrogenic duodenal perforation during hybrid endoscopic submucosal dissection (ESD) of a duodenal neuroendocrine tumor using endoscopic hand suturing (EHS), a method dedicated to closing mucosal defects after ESD.2 Recent indications suggest extending the suturing to include the muscle layer.3
A 68-year-old man was referred to our hospital for endoscopic treatment of a neuroendocrine tumor located on the anterior wall of the duodenal bulb, which was confirmed by biopsy. Preoperative endoscopic ultrasonography revealed no infiltration in the organ-muscle layer. Underwater hybrid ESD was performed using an DualKnife (Olympus), and a Boston 15-mm snare. After the submucosal injection and mucosal incision using a knife, resection was performed using a snare. Subsequently, an approximately 15-mm perforation of the duodenal bulb into the peritoneal cavity was observed. An attempt to cover the perforation with through-the-scope (TTS) clips was unsuccessful. Subsequently, the perforation was sutured using a needle holder EHSFG-260 (Olympus) and an absorbable suture VLOCL0604 (Covidien). The perforation was closed with a continuous suture that included the muscular layer and the mucosa, and the suture line was reinforced with two TTS clips. The suturing time was 85 minutes (Fig. 1).
The postoperative period was uneventful, and abdominal computed tomography with oral contrast revealed no signs of leakage. The patient was discharged seven days postoperatively. Histopathological results indicated R0 resection of the carcinoid tumor (grade 1, 18 mm in diameter) (Video 1).
EHS offers high efficacy and full-thickness closure of large perforations, notably in situations where alternative methods (e.g., clips and endoloops) prove ineffective, thus avoiding the need for surgical treatment. However, this procedure is technically difficult and time-consuming.
The authors declare that informed consent was obtained from the patient for the publication of his information and imaging.
Video 1. Endoscopic hand suturing procedure.
A video related to this article can be found online at https://doi.org/10.5946/ce.2024.117.
Fig. 1.
Procedure process. (A) A lesion before the procedure. (B) Perforation during endoscopic submucosal dissection. (C) Full-thickness defect of the duodenal wall after resection. Liver lobe is visible through the perforation site. (D) Closed perforation.
ce-2024-117f1.jpg
  • 1. Kato M, Kanai T, Yahagi N. Endoscopic resection of superficial non-ampullary duodenal epithelial tumor. DEN Open 2021;2:e54.ArticlePubMedPMCPDF
  • 2. Goto O, Sasaki M, Ishii H, et al. A new endoscopic closure method for gastric mucosal defects: feasibility of endoscopic hand suturing in an ex vivo porcine model (with video). Endosc Int Open 2014;2:E111–E116.ArticlePubMedPMC
  • 3. Masunaga T, Yahagi N, Kato M. Layered closure by endoscopic hand suturing involving the muscle layer for large defect after gastric endoscopic submucosal dissection. Dig Endosc 2024;36:384–385.ArticlePubMed

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        Successful iatrogenic duodenal perforation treatment with endoscopic hand suturing
        Clin Endosc. 2024;57(6):832-833.   Published online July 24, 2024
        DOI: https://doi.org/10.5946/ce.2024.117
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      Successful iatrogenic duodenal perforation treatment with endoscopic hand suturing
      Image
      Fig. 1. Procedure process. (A) A lesion before the procedure. (B) Perforation during endoscopic submucosal dissection. (C) Full-thickness defect of the duodenal wall after resection. Liver lobe is visible through the perforation site. (D) Closed perforation.

      Fig. 1.

      Successful iatrogenic duodenal perforation treatment with endoscopic hand suturing
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