Closure of leak at the tip of the “J” after ileal pouch-anal anastomosis using a novel over-the-scope clipping system
Objective: leaks from the body or the tip of the J-pouch can occur after restorative proctocolecotmy. Although it may follow an indolent clinical course, it often requires surgical repair or pouch revision. Here we describe a novel endoscopic approach to close the leak at the tip of the J pouch. Des...
| Main Authors: | , |
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| Format: | Article |
| Language: | English |
| Published: |
Thieme Revinter Publicações Ltda.
2014-04-01
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| Series: | Journal of Coloproctology |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2237936314000240 |
| _version_ | 1818619234805088256 |
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| author | Lei Lian Bo Shen |
| author_facet | Lei Lian Bo Shen |
| author_sort | Lei Lian |
| collection | DOAJ |
| description | Objective: leaks from the body or the tip of the J-pouch can occur after restorative proctocolecotmy. Although it may follow an indolent clinical course, it often requires surgical repair or pouch revision. Here we describe a novel endoscopic approach to close the leak at the tip of the J pouch. Design: pouchoscopy was performed under sedation and endoscopic over-the-scope clipping system was used for the management of a leak from the tip of a J-pouch. Results: under sedation, a pouchoscopy was performed and the deep tip of “J” leak was detected with a guidewire, along with water-contrasted pouchogram. The contained cavity from the leak was cleaned with hydrogen peroxide and 50% dextrose. Debridement of the epithelialized mouth of the leak was performed with an endoscopic cytology brush. Then endoscopic over-the-scope clipping system was used and the leak defect was completely closed. There was no bleeding or perforation. The entire procedure took 25 min. The patient continued to do well and reported resolution of the low back pain symptom. Conclusion: we reported the first case in the literature that a leak from the tip of a J-pouch was endoscopically occluded using a novel over-the-scope clipping system. Resumo: Objetive: vazamentos do corpo da bolsa e da extremidade da bolsa ileal em J podem ocorrer após proctocolectomia restauradora. Embora possam apresentar um curso clínico indolente, muitas vezes requerem procedimentos abdominais. Desenho: endoscopia da bolsa ileal foi realizada sob sedação e clipagem endoscópica usando o sistema “over-the-scope” foi utilizada para fechar um vazamento na extremidade da bolsa ileal em “J”. Resultados: sob sedação, uma endoscopia de bolsa ileal foi realizada e a extremidade profunda do vazamento da bolsa ileal em “J” foi detectada com um fio-guia. A cavidade que continha o vazamento foi limpa com peróxido de hidrogênio e 50% de dextrose. Desbridamento da borda epitelizada do vazamento foi realizada com uma escova de citologia endoscópica. Então o sistema endoscópico “over-the-scope” clip foi usado e o vazamento foi completamente fechado. Não houve sangramento ou perfuração. O processo todo levou 25 minutos. O paciente evoluiu bem e relatou a resolução do sintoma de dor lombar. Conclusão: relatamos o primeiro caso na literatura de vazamento na extremidade de bolsa ileal em J que foi fechado através de procedimento endoscópico usando um novo sistema “over-the-scope” clip (OTSC). Keywords: Ileal pouch anal anastomosis, Leak, Clipping, Endoscopy, Palavras-chave: Anastomose Bolsa ileal-anal, Vazamento, Clip, Endoscopia |
| first_indexed | 2024-12-16T17:34:15Z |
| format | Article |
| id | doaj.art-8df6801ba3034f11b088904e3fdb3a52 |
| institution | Directory Open Access Journal |
| issn | 2237-9363 |
| language | English |
| last_indexed | 2024-12-16T17:34:15Z |
| publishDate | 2014-04-01 |
| publisher | Thieme Revinter Publicações Ltda. |
| record_format | Article |
| series | Journal of Coloproctology |
| spelling | doaj.art-8df6801ba3034f11b088904e3fdb3a522022-12-21T22:22:50ZengThieme Revinter Publicações Ltda.Journal of Coloproctology2237-93632014-04-01342120123Closure of leak at the tip of the “J” after ileal pouch-anal anastomosis using a novel over-the-scope clipping systemLei Lian0Bo Shen1Digestive Disease Institute, The Cleveland Clinic Foundation, Cleveland, OH, USACorresponding author.; Digestive Disease Institute, The Cleveland Clinic Foundation, Cleveland, OH, USAObjective: leaks from the body or the tip of the J-pouch can occur after restorative proctocolecotmy. Although it may follow an indolent clinical course, it often requires surgical repair or pouch revision. Here we describe a novel endoscopic approach to close the leak at the tip of the J pouch. Design: pouchoscopy was performed under sedation and endoscopic over-the-scope clipping system was used for the management of a leak from the tip of a J-pouch. Results: under sedation, a pouchoscopy was performed and the deep tip of “J” leak was detected with a guidewire, along with water-contrasted pouchogram. The contained cavity from the leak was cleaned with hydrogen peroxide and 50% dextrose. Debridement of the epithelialized mouth of the leak was performed with an endoscopic cytology brush. Then endoscopic over-the-scope clipping system was used and the leak defect was completely closed. There was no bleeding or perforation. The entire procedure took 25 min. The patient continued to do well and reported resolution of the low back pain symptom. Conclusion: we reported the first case in the literature that a leak from the tip of a J-pouch was endoscopically occluded using a novel over-the-scope clipping system. Resumo: Objetive: vazamentos do corpo da bolsa e da extremidade da bolsa ileal em J podem ocorrer após proctocolectomia restauradora. Embora possam apresentar um curso clínico indolente, muitas vezes requerem procedimentos abdominais. Desenho: endoscopia da bolsa ileal foi realizada sob sedação e clipagem endoscópica usando o sistema “over-the-scope” foi utilizada para fechar um vazamento na extremidade da bolsa ileal em “J”. Resultados: sob sedação, uma endoscopia de bolsa ileal foi realizada e a extremidade profunda do vazamento da bolsa ileal em “J” foi detectada com um fio-guia. A cavidade que continha o vazamento foi limpa com peróxido de hidrogênio e 50% de dextrose. Desbridamento da borda epitelizada do vazamento foi realizada com uma escova de citologia endoscópica. Então o sistema endoscópico “over-the-scope” clip foi usado e o vazamento foi completamente fechado. Não houve sangramento ou perfuração. O processo todo levou 25 minutos. O paciente evoluiu bem e relatou a resolução do sintoma de dor lombar. Conclusão: relatamos o primeiro caso na literatura de vazamento na extremidade de bolsa ileal em J que foi fechado através de procedimento endoscópico usando um novo sistema “over-the-scope” clip (OTSC). Keywords: Ileal pouch anal anastomosis, Leak, Clipping, Endoscopy, Palavras-chave: Anastomose Bolsa ileal-anal, Vazamento, Clip, Endoscopiahttp://www.sciencedirect.com/science/article/pii/S2237936314000240 |
| spellingShingle | Lei Lian Bo Shen Closure of leak at the tip of the “J” after ileal pouch-anal anastomosis using a novel over-the-scope clipping system Journal of Coloproctology |
| title | Closure of leak at the tip of the “J” after ileal pouch-anal anastomosis using a novel over-the-scope clipping system |
| title_full | Closure of leak at the tip of the “J” after ileal pouch-anal anastomosis using a novel over-the-scope clipping system |
| title_fullStr | Closure of leak at the tip of the “J” after ileal pouch-anal anastomosis using a novel over-the-scope clipping system |
| title_full_unstemmed | Closure of leak at the tip of the “J” after ileal pouch-anal anastomosis using a novel over-the-scope clipping system |
| title_short | Closure of leak at the tip of the “J” after ileal pouch-anal anastomosis using a novel over-the-scope clipping system |
| title_sort | closure of leak at the tip of the j after ileal pouch anal anastomosis using a novel over the scope clipping system |
| url | http://www.sciencedirect.com/science/article/pii/S2237936314000240 |
| work_keys_str_mv | AT leilian closureofleakatthetipofthejafterilealpouchanalanastomosisusinganoveloverthescopeclippingsystem AT boshen closureofleakatthetipofthejafterilealpouchanalanastomosisusinganoveloverthescopeclippingsystem |