Metallic clip-associated colonic perforation after peroral endoscopic myotomy: A case report

doi:10.4240/wjgs.121137

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World Journal of Gastrointestinal Surgery

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1948-9366

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Case Report

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastrointest Surg. Aug 27, 2026; 18(8): 121137
Published online Aug 27, 2026. doi: 10.4240/wjgs.121137

Metallic clip-associated colonic perforation after peroral endoscopic myotomy: A case report

Geng-Yuan Zhang, Shi-Gong Chen, Zhong-Ti Gao, Zhu-Tang Huang, Sheng-Fu Che, Long Li, Bo Long, Fei-Fei Ding, Ze-Yuan Yu, Hui-Nian Zhou, Zuo-Yi Jiao

Geng-Yuan Zhang, Shi-Gong Chen, Zhong-Ti Gao, Zhu-Tang Huang, Sheng-Fu Che, Long Li, Bo Long, Ze-Yuan Yu, Hui-Nian Zhou, Zuo-Yi Jiao, Department of General Surgery, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou 730030, Gansu Province, China

Fei-Fei Ding, Department of Gastroenterology, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou 730030, Gansu Province, China

Co-first authors: Geng-Yuan Zhang and Shi-Gong Chen.

Co-corresponding authors: Hui-Nian Zhou and Zuo-Yi Jiao.

Author contributions: Zhang GY and Chen SG contributed equally to this work as co-first authors; Zhang GY, Chen SG, Zhou HN, and Jiao ZY conceptualized and wrote the original draft; Gao ZT, Huang ZT, Che SF, Li L, Long B, and Yu ZY reviewed and edited the manuscript; Zhang GY, Chen SG, Gao ZT, Zhou HN, and Jiao ZY performed the operation; Gao ZT, Huang ZT, and Ding FF provided the pictures; Zhang GY, Chen SG, Zhou HN, and Jiao ZY critically revised the manuscript; Zhou HN and Jiao ZY contributed equally as co-corresponding authors. All authors have read and approved the final manuscript.

AI contribution statement: We used DeepSeek (DeepSeek-V3.2) to assist with language editing. All AI-generated suggestions were critically reviewed and refined by the authors, who take full responsibility for the final content and integrity of the work.

Supported by National Natural Science Foundation of China, No. 82460459; Gansu Provincial Health and Wellness Industry Scientific Research Project, No. GSWSKY2024-03; Cuiying Scientific and Technological Innovation Program of Lanzhou University Second Hospital, No. CY2022-QN-A13; and Lanzhou Science and Technology Plan Project, No. 2023-4-26.

Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).

Corresponding author: Zuo-Yi Jiao, Professor, Department of General Surgery, The Second Hospital & Clinical Medical School, Lanzhou University, No. 82 Cuiying Gate, Chengguan District, Lanzhou 730030, Gansu Province, China. jiaozy@lzu.edu.cn

Received: March 21, 2026
Revised: May 14, 2026
Accepted: June 26, 2026
Published online: August 27, 2026
Processing time: 150 Days and 16.2 Hours

Core Tip

Core Tip: Colonic perforation potentially related to metallic clip migration after peroral endoscopic myotomy is an unprecedented complication. This case of a 48-year-old woman with achalasia and chronic constipation demonstrates that clip dislodgement may lead to clip-associated acute sigmoid colon perforation, requiring urgent sigmoid colectomy with colostomy. Clinicians should remain vigilant for sudden abdominal pain in post-peroral endoscopic myotomy patients, especially those with chronic constipation, and consider clip-associated injury as a potential etiology.