Repair of post polypectomy colonic perforation by Endoclip: a case report

A 73-year-old woman was admitted to evaluate for iron deficiency anemia, increased serum creatinine, and ascites. Her colonoscopy revealed a polyp at the junction of sigmoid and descending colon, and after polypectomy, a 6 mm colonic perforation was seen. The perforation was detected by radiography and CT scan; and beside conservative management and antibiotics, her perforation was closed by using Endoclip. The patient was observed and discharged from hospital without any surgery 5 days later, and in follow-up there was no problem regarding perforation. Resumo: Mulher, 73 anos, internada para avaliação para anemia ferropriva, com aumento da creatinina sérica e ascite. A colonoscopia revelou um pólipo na junção dos colos sigmoide e descendente e, em seguida à polipectomia, foi observada uma perfuração de 6 mm no cólon, comprovada por radiografias e tomografia computadorizada. Além do tratamento conservador e da antibioticoterapia, a perfuração foi ocluída com Endoclip. A paciente ficou sob observação e recebeu alta do hospital sem qualquer cirurgia 5 dias mais tarde. Durante o seguimento, não foram observados problemas com relação à perfuração. Keywords: Polypectomy, Colonic perforation, Endoclip, Palavras-chave: Polipectomia, Perfuração de cólon, Endocli

Oral n-acetyl cysteine versus rectal indomethacin for prevention of post ercp pancreatitis: A multicenter multinational randomized controlled trial

Background: This multicenter multinational RCT designed to compare the efficacy of suppository indomethacin and NAC for prevention of PEP.Methods: During a 6-month period, all of the ERCP cases in seven referral centers were randomly assigned to receive either 1200 mg oral NAC, indomethacin suppository 100 mg, 1200 mg oral NAC plus indomethacin suppository 100 mg or placebo 2 hours before ERCP. The primary outcomes were the rate and severity of any PEP.Results: A total of 432 patients included (41.4% male). They were originally citizens of 6 countries (60.87% Caucasian). They were randomly allocated to receive either NAC (group A, 84 cases), rectal indomethacin (group B, 138 cases), NAC + rectal indomethacin (group C, 115 cases) or placebo (group D, 95 cases). The rate of PEP in groups A, B and C in comparison with placebo were 10.7%, 17.4%, 7.8% vs 20% (P=0.08, 0.614 & 0.01 respectively). The NNT for NAC, indomethacin and NAC + indomethacin was 11, 38 and 8 respectively.Conclusion: Oral NAC is more effective than rectal indomethacin when compared to placebo for prevention of PEP and the combination of NAC and Indomethacin had the lowest incidence of PEP and may have synergistic effect in preventing of PEP (IRCT20201222049798N1; 29/12/2020)