Endoscopic band ligation for closure of GI perforations in a porcine animal model (with video)

Background: GI perforations occur rarely during endoscopy but have life-threatening implications. Objective: To evaluate endoscopic band ligation (EBL) for closure of acute GI perforations by using a porcine model. Design: Investigator-initiated interventional pilot study by using an in vivo porcine model. Setting: Tertiary-care institution. Subjects: Ten domestic pigs. Intervention: Each animal underwent a single endoscopic procedure, with creation of a single GI lumen perforation. Perforations of 10 to 20mmwere created in the esophagus, stomach, duodenum, and colon. EBL was used for closure. Fourteen days later, the pigs were killed, microbial cultures were obtained, and histologic review was done. Main Outcome Measurements: Immediate and delayed endoscopic closure of the perforation site, evidence of clinical peritonitis during the 14-day follow-up. Results: Ten pigs completed the protocol and survived without clinical peritonitis during the 14-day follow-up. Endoscopic closure of a 15-mm esophageal perforation failed, thus, no attempt was made to close a 20-mm esophageal perforation. Closure of all other perforations was successful. At necropsy, fibrinous peritonitis was suspected in one animal with a 10-mm duodenal perforation. Chronic inflammation and fibroplasia at the perforation sites were the most common histologic findings. Limitations: The applicability of widespread use in humans remains unknown despite successful case reports in the medical literature. Conclusion: EBL can be used successfully to close 10 to 20 mm perforations within normal stomach, duodenum, and colon and can prevent clinically relevant intra-abdominal infections. However, for esophageal perforations, closure may be limited to small (≤10 mm), iatrogenic perforations.