WASHINGTON, D.C. - To prevent colon cancer, the second leading cause of United States cancer deaths, the American Cancer Society recommends that after age 50 people undergo colonoscopies every ten years to detect signs of that disease - either actual tumors or precancerous polyps.

But in one out of every 1,000 to 2,000 colonoscopies, doctors inadvertently perforate - or puncture - the colon. Most of these patients need urgent surgery to close the wound and spend 10 days in the hospital. One in 10 dies, usually because delays in closing perforations allow colon contents to leak into the abdominal cavity, causing deadly conditions such as peritonitis and sepsis.

Now, however, in a series of animal studies, researchers at the University of Texas Medical Branch at Galveston (UTMB) have developed a technique for closing perforations promptly after they are recognized by using clips or sutures that can be inserted through the anus via endoscope, thus avoiding invasive surgery. Similar clips and sutures have been used for some time by surgeons performing minimally invasive laparoscopic procedures - including several gynecological operations and other procedures such as gall bladder removal.

At this month's annual meeting of the American Society of Gastrointestinal Endoscopy, UTMB professor G.S. Raju, the principal investigator for the wound-repair studies, presented a summary of his experimental endoscopic research over the last three years.

Working with pigs as an experimental model, Raju and his team first successfully closed colon perforations of less than one inch with small metal clips inserted via endoscopes.

During colonoscopies, surgeons accidentally may cause two principal types of perforations, Raju explained. One results from over-stretching the colon, the other from removal of polyps. (Incomplete removal of polyps may cause adhesions, in which the remaining portion of the polyp sticks to the colon wall.) "We have shown in a series of experiments that both types of perforations can be closed successfully using an endoscope without the need for invasive surgery," Raju reported. He added: "We have even accomplished a leak-proof seal of the perforation."

Encouraged by the preliminary work done at UTMB, InScope, a branch of Ethicon Endosurgical of Cincinnati, invited Raju to initiate and lead a multi-center animal study comparing surgical closure with endoscopic efforts to close a gaping, 1.6-inch-wide colon perforation using new clips and sutures. Other institutions joining in the multi-center trial included academic medical centers at Dartmouth University and the University of Cincinnati, and at medical schools in Great Britain and Sweden. "The results are encouraging," Raju said: "As good as surgery in closing perforations, better than surgery in reducing adhesions."

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