Postgraduate Course at DDW: Complete Clinical Updates for Today's Practice | May 2025-6_Raju-Management of Perforation During Polypectomy

6_Raju-Management of Perforation During Polypectomy

Pdf Summary

The document, "Management of Perforation During Polypectomy" by G. S. Raju, MD, outlines strategies for handling perforations during polypectomy, a common complication in endoscopic procedures. It highlights the roles of closure devices, technicians, and endoscopists in efficiently managing such occurrences. <br /><br />Closure devices, specifically through-the-scope clips, are recommended as the preferred method for closing perforations rapidly, typically within 1 cm of occurrence. The text covers various types of clips adaptable to differing situations, accentuating their immediate application to avert further complications. <br /><br />The document stresses the significance of endoscopy technicians and their training, ensuring they are equipped to deploy clips accurately and efficiently. The technician’s ability to operate clips, from opening and closing to confirming deployment, is crucial.<br /><br />For the endoscopist, mastering the art of clipping, both superficial and deep, is essential. Techniques such as pushing gently on closure and employing thorough photo documentation help ensure successful outcomes and provide critical insights for further surgical evaluation if necessary. The risks of clip failure, including potential leaks and interference with laparoscopic closure, are also discussed, supported by references to studies.<br /><br />Patient reassurance is a key responsibility of the endoscopist, emphasizing that perforations can often be managed non-surgically. The document advocates for principles that prevent perforation, such as maintaining a clean colon and carefully assessing the depth of resection to avoid muscle entrapment. <br /><br />For severe perforation cases, particularly with contamination, further interventions such as hospitalizing vulnerable patients, administering broad-spectrum antibiotics, and performing CT scans are recommended, with surgery as a last resort. The overall goal is to manage post-polypectomy defects effectively, mitigating risks like pneumoperitoneum and peritonitis through timely endoscopic closure or surgery if necessary.

Keywords

perforation management

polypectomy complications

closure devices

endoscopy technicians

through-the-scope clips

endoscopist techniques

patient reassurance

non-surgical management

post-polypectomy defects

surgical intervention