Post written by Paola Soriani, MD, from the Digestive Endoscopy Unit, Azienda USL Modena, Ramazzini Hospital, Carpi, Italy.
An 89-year-old woman underwent colonoscopy. In a setting of severe diverticular disease, a perforation of 20-25 mm occurred in the sigmoi-rectal juntion. The leakage was completely closed after the deployment of 2 over-the-scope clips, tightly adjacent to each other.
We reported this video to show the usefulness of OTSC in resolving iatrogenic perforations and avoiding surgical repair in challenging situations. Due to their size and shape, closed deployment of 2 clips can be difficult, especially in angulated sites. When a iatrogenic perforation happens, we should keep calm, work safe, and consider all minimally invasive and effective exit strategies to avoid surgery, especially in high-risk patients.
In case of iatrogenic perforation less than 25 mm, we advice OTSC deployment with suction technique because of the soft edges of the leakage, while in larger leaks twin graspers can be useful in edge approximation.
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