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Chirurgie 12. September 2014

Over-the-scope endoclipping for foregut leaks and perforations

Background: Foregut leaks and perforations continue to account for high morbidity and mortality rates. Novel endoscopic techniques have recently changed the approach to the management of these complications. The purpose of this study was to evaluate the efficacy and safety of the Over-The-Scope Clipping system (OTSC) in a consecutive series of patients presenting with foregut leaks and perforations.

Patients and methods: We retrospectively reviewed the charts of seven consecutive patients treated between November 2010 and December 2013 in our tertiary care hospital. A parallel review of the literature was made including only patients treated with OTSC after upper gastrointestinal surgery.

Results: The median time between surgery and OTSC clipping was 18.4 days (range 7–53), and the median size of the defect was 6 mm (range 2–10). The overall OTSC success rate was 85.7 %. In 6 patients, 3 of whom had a chronic leak, the OTSC was successfully used as first-line treatment. The literature review showed that the overall success rate of the OTSC procedure was 66.7 % in esophageal defects and 80 % in gastric defects.

Conclusions: The OTSC system is a simple and safe method for the management of postoperative foregut leaks and perforations, resulting in complete and durable closure of small (< 1 cm) visceral defects. Use of the OTSC system, along with drainage of perivisceral collections, may represent a safe alternative to stents in selected patients.

A. Aiolfi, D. Bona, E. Asti, S. Siboni, L. Pogliani, Prof. L. Bonavina, European Surgery 4/2014

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