Su1599 Endoscopic Band Ligation for Closure of Gastrointestinal Perforations Using a Porcine Animal Model

Su1598 Endoscopic Treatment of Actively Bleeding Portal Hypertensive Gastropathy in Cirrhosis Mamdouh Gabr*, Moemen M. Gabr Gastroenterology, Tanta Faculty of Medicine, Tanta, Egypt Introduction: Portal hypertensive gastropathy (PHG) occurs as a complication of cirrhotic and non-cirrhotic portal hypertension. PHG is mostly asymptomatic, although it may bleed acutely leading to hematemesis and/or melena, this presentation is less frequent than chronic blood loss. The diagnosis of acute GI bleeding from PHG is established when active bleeding from gastropathy lesions or when removable clots overlying these lesions is observed when there is PHG and no other cause of acute bleeding can be demonstrated thorough evaluation of the GI tract. Given its low frequency, the experience in the management of acute hemorrhage from PHG is also limited. Only small uncontrolled studies have evaluated the treatment of acute PHG bleeding. Endoscopic treatment for acute PHG bleeding has been little studied. Only one study has evaluated the use of endoscopic treatment of PHG with APC in chronic PHG bleeding with good result. Herein, we report our experience in the control of actively bleeding PHG in a group of cirrhotic patients. AimsM (2) surgical intervention; or (3) endoscopic intervention. Endoscopic interventions include use of endoscopic through-the-scope and over-the-scope clips (OTSC), and endoscopic sutures, each with inherent limitations. Endoscopic band ligation (EBL) is commonly utilized for obliteration of esophageal varices and there are case reports using it for perforation closure. We hypothesized that EBL could be applied for immediate closure of luminal perforations. Aim: Evaluate technical closure and complication-free survival for 14 days after endoscopic band ligation of smallto moderate-sized perforations (1-2 cm) within the GI tract using an animal model. Methods: Asingle-center, investigator-initiated pilot study to evaluate the feasibility of EBL closure using an in vivo porcine model was performed. Each animal underwent a single endoscopic procedure created with electrocautery and a needle knife freehand puncture. The perforation site was enlarged using a dilating balloon of one of three sizes: 10mm, 15mm, or 20mm. Four anatomic locations were chosen (one per animal): esophagus, stomach, duodenum, and colon. Pre-procedure and post-procedure antibiotics were administered for the subsequent 7 days. Animals were survived for 14 days post-procedure then humanely sacrificed. Necropsy was performed and the location of the perforation was resected and examined grossly and also sent for histologic evaluation. Results: The results are shown in Table 1. Ten domestic pigs (mean weight 40kg) completed the research protocol. All pigs within the stomach, duodenum, and colon group completed the protocol. Only one pig (1.0cm perforation) completed the protocol. A median of 1.8 bands (range 1-6) was required to close the perforation site. In all pigs that immediate endoscopic closure was achieved survived 14 days without clinical peritonitis. In 3 cases (1 duodenum, 2 colon) the perforation was not closed at necropsy and in these animals initial closure was obwww.giejournal.org Vol tained by suctioning and securing omental fat. Conclusions: Endoscopic band ligation can be used for successful closure of 1-2cm iatrogenic perforations of healthy tissue within the stomach, duodenum, and colon and with prevention of clinically-relevant intra-abdominal infections. Closure of esophageal perforations in the pig model could only be achieved for small (%1 cm) iatrogenic injuries. Studies in humans are needed to support these findings. Table 1. Perforation Study Results Location/Size of Perforation ume 79, No. 5S Immediate Endoscopic Closure? : 2014 GAST Number of Bands Placed ROINTESTIN Survived for 14 days? AL ENDOSC Hole Closed at Necropsy? Esophagus: 10 mm 15 mm 20 mm Yes No No attempt 1 0 N/A Yes No N/A Yes No N/A