Background
The over-the-scope clip (OTSC) provides more durable and full-thickness closure as
compared with standard clips. Only case reports and small case series have reported
on outcomes of OTSC closure of GI defects.
Objective
To describe a large, multicenter experience with OTSCs for the management of GI defects.
Secondary goals were to determine success rate by type of defect and type of therapy
and to determine predictors of treatment outcomes.
Design
Multicenter, retrospective study.
Setting
Multiple, international, academic centers.
Patients
Consecutive patients who underwent attempted OTSC placement for GI defects, either
as a primary or as a rescue therapy.
Interventions
OTSC placement to attempt closure of GI defects.
Main Outcome Measurements
Long-term success of the procedure.
Results
A total of 188 patients (108 fistulae, 48 perforations, 32 leaks) were included. Long-term
success was achieved in 60.2% of patients during a median follow-up of 146 days. Rate
of successful closure of perforations (90%) and leaks (73.3%) was significantly higher
than that of fistulae (42.9%) (P < .05). Long-term success was significantly higher when OTSCs were applied as primary
therapy (primary 69.1% vs rescue 46.9%; P = .004). On multivariate analysis, patients who had OTSC placement for perforations
and leaks had significantly higher long-term success compared with those who had fistulae
(OR 51.4 and 8.36, respectively).
Limitations
Retrospective design and multiple operators with variable expertise with the OTSC
device.
Conclusion
OTSC is safe and effective therapy for closure of GI defects. Clinical success is
best achieved in patients undergoing closure of perforations or leaks when OTSC is
used for primary or rescue therapy. Type of defect is the best predictor of successful
long-term closure.
Abbreviations:
APC (argon plasma coagulation), OTSC (over-the-scope clip), SEMS (self-expandable metal stent.)To read this article in full you will need to make a payment
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References
- Enteric fistulas: principles of management.J Am Coll Surg. 2009; 209: 484-491
- Managing complications associated with laparoscopic Roux-en-Y gastric bypass for morbid obesity.Can J Surg [Journal Canadien de Chirurgie]. 2012; 55: 329-336
- Decreasing anastomotic and staple line leaks after laparoscopic Roux-en-Y gastric bypass.Surg Endosc. 2009; 23: 1403-1408
- Laparoscopy-assisted pancreas- and spleen-preserving total gastrectomy for gastric cancer as compared with open total gastrectomy.Surg Endosc. 2009; 23: 2416-2423
- LATG with extracorporeal esophagojejunostomy: Is this minimal invasive surgery for gastric cancer?.J Laparoendosc Adv Surg Tech, Part A. 2008; 18: 572-578
- The effects of laparoscopic assisted total gastrectomy on surgical outcomes in the treatment of gastric cancer.J Korean Surg Soc. 2011; 80: 245-250
- Anastomotic leak is not associated with oncologic outcome in patients undergoing low anterior resection for rectal cancer.Ann Surg. 2012; 256: 1034-1038
- Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis.Ann Surg. 2011; 253: 890-899
- Prognosis after anastomotic leakage in colorectal surgery.Dis Colon Rect. 2005; 48: 1021-1026
- Multivariate analysis of risk factors for death following gastric bypass for treatment of morbid obesity.Ann Surg. 2004; 239 (discussion 3): 698-702
- Factors affecting morbidity and mortality of Roux-en-Y gastric bypass for clinically severe obesity: an analysis of 1,000 consecutive open cases by a single surgeon.J Gastrointest Surg. 2007; 11: 500-507
- Laparoscopic sleeve gastrectomy for morbid obesity: 5 years experience from an Asian center of excellence.Obes Surg. 2013; 23: 939-946
- Colonoscopy-associated perforation: a 7-year survey of in-hospital frequency, treatment and outcome in a German university hospital.Colorect Dis. 2012; 14: 1121-1125
- Predictive risk factors of perforation in gastric endoscopic submucosal dissection for early gastric cancer: a large, multicenter study.Surg Endosc. 2013; 27: 1372-1378
- Incidence, risk, management, and outcomes of iatrogenic full-thickness large bowel injury associated with 56,882 colonoscopies in 14 Lithuanian hospitals.Surg Endosc. 2013; 27: 1628-1635
- Endoscopic management of colonoscopic perforations (with videos).Gastrointest Endosc. 2011; 74: 1380-1388
- Analysis of colonoscopic perforations at a local clinic and a tertiary hospital.W J Gastroenterol. 2012; 18: 4898-4904
- Treatment and outcomes of iatrogenic colon perforations at a community teaching hospital.Am Surg. 2012; 78: 975-978
- Colonoscopic perforations: a review of 30,366 patients.Surg Endosc. 2007; 21: 994-997
- Trends in perforated peptic ulcer: incidence, etiology, treatment, and prognosis.W J Surg. 2000; 24: 277-283
- Fully covered self-expandable metal stents (SEMS), partially covered SEMS and self-expandable plastic stents for the treatment of benign esophageal ruptures and anastomotic leaks.BMC Gastroenterol. 2012; 12: 19
- Endoscopic clip closure versus surgery for the treatment of iatrogenic colon perforations developed during diagnostic colonoscopy: a review of 115,285 patients.Surg Endosc. 2013; 27: 501-504
- The use of endoscopic clipping devices in the treatment of iatrogenic duodenal perforation.Gastroenterol Hepatol. 2010; 6: 660-661
- Advances in the management of esophageal perforation.Thorac Surg Clin. 2011; 21: 541-555
- Utility of removable esophageal covered self-expanding metal stents for leak and fistula management.Ann Thorac Surg. 2010; 89 (discussion 6-7): 931-936
- Randomized controlled trial comparing endoscopic clips and over-the-scope clips for closure of natural orifice transluminal endoscopic surgery gastrotomies.Endoscopy. 2009; 41: 1056-1061
- Endoscopic closure devices.Gastrointest Endosc. 2012; 76: 244-251
- Performance of the OTSC System in the endoscopic closure of iatrogenic gastrointestinal perforations: a systematic review.Surg Endosc. 2013; 27: 2258-2274
- Performance of the OTSC System in the endoscopic closure of gastrointestinal fistulae—a meta-analysis.Min Inv Ther Allied Tech. 2012; 21: 249-258
- Endoscopic closure of GI fistulae by using an over-the-scope clip (with videos).Gastrointest Endosc. 2010; 72: 1289-1296
- Application of the OTSC system for the closure of fistulas, anastomosal leakages and perforations within the gastrointestinal tract [German].Zeitschrift fur Gastroenterologie. 2011; 49: 981-985
- The anal fistula claw: the OTSC clip for anal fistula closure.Colorect Dis. 2012; 14: 1112-1117
- Endoscopic closure of postoperative esophageal leaks with a novel over-the-scope clip system.Endoscopy. 2010; 42: 757-759
- Rectal perforations and fistulae secondary to a glycerin enema: closure by over-the-scope-clip.W J Gastroenterol. 2012; 18: 3177-3180
- Endoscopic closure of postoperative gastrointestinal leakages and fistulas with the over-the-scope clip (OTSC).J Gastrointest Surg. 2013; 17: 1058-1065
- Endoscopic treatment of gastrointestinal fistulas using an over-the-scope clip (OTSC) device: case series from a tertiary referral center.Endoscopy. 2011; 43: 545-548
- The over-the-scope clip system—a novel technique for gastrocutaneous fistula closure: the first North American experience.Can J Gastroenterol. 2012; 26: 193-195
- The over-the-scope clip (OTSC) for the treatment of gastrointestinal bleeding, perforations, and fistulas.Surg Endosc. 2011; 25: 2901-2905
- Over-the-scope clip application yields a high rate of closure in gastrointestinal perforations and may reduce emergency surgery.J Gastrointest Surg. 2012; 16: 2132-2138
- Endoscopic closure of gastrointestinal defects with an over-the-scope clip device. A case series and review of the literature.Clin Res Hepatol Gastroenterol. 2012; 36: 614-621
- Endoscopic treatment of postgastrectomy duodenal fistula with an over-the-scope clip.Surg Innov. 2011; 18: 102-104
- Efficacy of the over-the-scope clip (OTSC) for treatment of colorectal postsurgical leaks and fistulas.Surg Endosc. 2012; 26: 3330-3333
- The use of over the scope clip (OTSC) device for sleeve gastrectomy leak.J Gastrointest Surg. 2013; 17: 606-608
- Anastomotic leak after low anterior resection: a spectrum of clinical entities.JAMA Surg. 2013; 148: 177-182
- Enterocutaneous fistulae.J Wound Care. 1999; 8: 141-142
- A retrospective analysis of early and late outcome of biodegradable stent placement in the management of refractory anastomotic colorectal strictures.Surg Endosc. 2013; 27: 2487-2491
- Endoscopic clips: past, present and future.Can J Gastroenterol. 2009; 23: 158-160
- Successful endoscopic management of postoperative GI fistula with fibrin glue injection: report of two cases.Gastrointest Endosc. 2004; 60: 460-463
- The temporary placement of covered self-expandable metal stents to seal various gastrointestinal leaks after surgery.Gut Liver. 2013; 7: 112-115
- Use of an over-the-scope clipping device: multicenter retrospective results of the first U.S. experience (with videos).Gastrointest Endosc. 2012; 76: 202-208
Article info
Publication history
Published online: June 04, 2014
Accepted:
March 27,
2014
Received:
October 2,
2013
Footnotes
DISCLOSURE: M. Khashab is a consultant for Boston Scientific and Olympus America and received research funding from Cook Medical. J.-W. Poley is a consultant for Cook Medical and Boston Scientific. C. Thompson is a consultant for Apollo Endosurgery. E. Goldberg is a consultant for Olympus America and Boston Scientific. D. Schembre has a royalty agreement with and is on the speakers' bureau for Cook Medical and is a consultant for Boston Scientific. M. Hasan is a consultant for Boston Scientific. S. Varadarajulu is a consultant for Boston Scientific and Olympus America. R. Hawes is a consultant for Boston Scientific, Cook Medical, and Olympus America. All other authors disclosed no financial relationships relevant to this publication.
See CME section; p. 679.
Identification
Copyright
© 2014 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
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- Over-the-scope clip in the management of GI defectsGastrointestinal EndoscopyVol. 80Issue 4
- PreviewGI defects, regardless of etiology, are challenging and often intimidating management scenarios for endoscopists. Perforation during upper and lower GI endoscopy is relatively rare; however, its occurrence does convey significant morbidity and potential mortality for the affected patient. The risk of iatrogenic perforation also rises as the repertoire of the advanced endoscopist broadens to include more advanced procedures such as EMR and endoscopic submucosal dissection. Recent advancements in equipment also have led to successful endoscopic management of fistulas and postoperative leaks.
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