# Endoscopic management of duodenal perforations during endoscopic ultrasound: a case series

## TL;DR

This study shows that using an over-the-scope clip can safely and effectively close duodenal perforations caused during endoscopic ultrasound procedures.

## Contribution

The paper presents a novel case series demonstrating the efficacy of OTSC for managing iatrogenic duodenal perforations during EUS.

## Key findings

- Four cases of duodenal perforation were successfully managed endoscopically without surgery.
- Perforation sizes up to 15 mm were effectively closed using an over-the-scope clip.
- Early detection and intervention reduced complications and improved recovery.

## Abstract

The study aimed to investigate the feasibility and safety of using an over-the-scope clip (OTSC)for closing duodenal perforations caused by endoscopic ultrasound (EUS) procedures, as well as to evaluate the efficacy of definitive management strategies for duodenal perforations induced during EUS.

A retrospective analysis was conducted involving patients who developed iatrogenic duodenal perforations during linear EUS at the Digestive Endoscopy Center of Beijing Friendship Hospital, Capital Medical University, from January 2017 to December 2024. Diagnoses, management, and outcomes were identified and retrospectively reviewed in four of these patients.

Among 5,174 linear EUS procedures, four cases of perforation occurred (0.077%). All patients were women, with a mean age of 76 years (range: 71–81). Perforations were caused by the curvilinear probe in all cases: Three during diagnostic EUS procedures and one after EUS-guided fine-needle aspiration biopsy. Defect sizes ranged from 3 mm to 15 mm. All perforations with conservative endoscopic management were successfully closed without surgical intervention. The hospitalization duration varied widely, ranging from 32 to 92 days, due to differences in the clinical conditions of the inpatients.

Endoscopic closure of iatrogenic duodenal perforations ≤ 15 mm using an OTSC is safe and effective when performed by experienced endoscopists. Early identification of perforation, guided by clinical symptoms and risk factors, followed by rapid evaluation and endoscopic intervention, may reduce complications and facilitate recovery.