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Erschienen in: European Surgery 4/2014

01.08.2014 | Original Article

Over-the-scope endoclipping for foregut leaks and perforations

verfasst von: A. Aiolfi, D. Bona, E. Asti, S. Siboni, L. Pogliani, Prof. L. Bonavina

Erschienen in: European Surgery | Ausgabe 4/2014

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Summary

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.
Literatur
1.
Zurück zum Zitat Mennigen R, Colombo-Benkmann M, Senninger N, et al. Endoscopic closure of postoperative gastrointestinal leakages and fistulas with the Over-the-Scope Clip (OTSC). J Gastrointest Surg. 2013;17(6):1058–65.PubMedCrossRef Mennigen R, Colombo-Benkmann M, Senninger N, et al. Endoscopic closure of postoperative gastrointestinal leakages and fistulas with the Over-the-Scope Clip (OTSC). J Gastrointest Surg. 2013;17(6):1058–65.PubMedCrossRef
2.
Zurück zum Zitat Van Boeckel PG, Sijbring A, Vleggaar FP, et al. Systematic review: temporary stent placement for benign rupture or anastomotic leaks of the esophagus. Aliment Pharmacol Ther. 2011;33(4):1292–301.PubMedCrossRef Van Boeckel PG, Sijbring A, Vleggaar FP, et al. Systematic review: temporary stent placement for benign rupture or anastomotic leaks of the esophagus. Aliment Pharmacol Ther. 2011;33(4):1292–301.PubMedCrossRef
3.
Zurück zum Zitat Dasari BV, Neely D, Kennedy A, et al. The role of esophageal stents in the management of esophageal anastomotic leaks and benign esophageal perforations. Ann Surg. 2014;259(5):852–60.PubMedCrossRef Dasari BV, Neely D, Kennedy A, et al. The role of esophageal stents in the management of esophageal anastomotic leaks and benign esophageal perforations. Ann Surg. 2014;259(5):852–60.PubMedCrossRef
4.
Zurück zum Zitat Bona D, Laface L, Bonavina L, et al. Covered nitinol stents for the treatment of esophageal strictures and leaks. World J Gastroenterol. 2010;16(18):2260–4.PubMedCentralPubMedCrossRef Bona D, Laface L, Bonavina L, et al. Covered nitinol stents for the treatment of esophageal strictures and leaks. World J Gastroenterol. 2010;16(18):2260–4.PubMedCentralPubMedCrossRef
5.
Zurück zum Zitat Rodella L, Laterza E, De Manzoni G, et al. Endoscopic clipping of anastomotic leakages in esophagogastric surgery. Endoscopy. 1998;30(5):453–6.PubMedCrossRef Rodella L, Laterza E, De Manzoni G, et al. Endoscopic clipping of anastomotic leakages in esophagogastric surgery. Endoscopy. 1998;30(5):453–6.PubMedCrossRef
6.
Zurück zum Zitat Kirschniak A, Subotova N, Zieker D, et al. The Over-The-Scope Clip (OTSC) for the treatment of gastrointestinal bleeding, perforations, and fistulas. Surg Endosc. 2011;25(9):2901–5.PubMedCrossRef Kirschniak A, Subotova N, Zieker D, et al. The Over-The-Scope Clip (OTSC) for the treatment of gastrointestinal bleeding, perforations, and fistulas. Surg Endosc. 2011;25(9):2901–5.PubMedCrossRef
7.
Zurück zum Zitat Voermans RP, Le Moine O, von Renteln D, et al. Efficacy of endoscopic closure of acute perforation of the gastrointestinal tract. Clin Gastroenterol Hepatol. 2012;10(6):603–8.PubMedCrossRef Voermans RP, Le Moine O, von Renteln D, et al. Efficacy of endoscopic closure of acute perforation of the gastrointestinal tract. Clin Gastroenterol Hepatol. 2012;10(6):603–8.PubMedCrossRef
8.
Zurück zum Zitat Parodi A, Repici A, Pedroni A, et al. Endoscopic management of GI perforations with a new over-the-scope clip device (with videos). Gastrointest Endosc. 2010;72(4):881–6.PubMedCrossRef Parodi A, Repici A, Pedroni A, et al. Endoscopic management of GI perforations with a new over-the-scope clip device (with videos). Gastrointest Endosc. 2010;72(4):881–6.PubMedCrossRef
9.
Zurück zum Zitat Pohl J, Borgulya M, Lorenz D, et al. Endoscopic closure of postoperative esophageal leaks with a novel over-the-scope clip system. Endoscopy. 2010;42(9):757–9.PubMedCrossRef Pohl J, Borgulya M, Lorenz D, et al. Endoscopic closure of postoperative esophageal leaks with a novel over-the-scope clip system. Endoscopy. 2010;42(9):757–9.PubMedCrossRef
10.
Zurück zum Zitat Von Renteln D, Denzer UW, Schachschal G, et al. Endoscopic closure of GI fistulae by using an over-the-scope clip (with videos). Gastrointest Endosc. 2010;72(6):1289–96.CrossRef Von Renteln D, Denzer UW, Schachschal G, et al. Endoscopic closure of GI fistulae by using an over-the-scope clip (with videos). Gastrointest Endosc. 2010;72(6):1289–96.CrossRef
11.
Zurück zum Zitat Seebach L, Bauerfeind P, Gubler C. “Sparing the surgeon": clinical experience with over-the-scope clips for gastrointestinal perforation. Endoscopy. 2010;42(12):1108–11.PubMedCrossRef Seebach L, Bauerfeind P, Gubler C. “Sparing the surgeon": clinical experience with over-the-scope clips for gastrointestinal perforation. Endoscopy. 2010;42(12):1108–11.PubMedCrossRef
12.
Zurück zum Zitat Manta R, Manno M, Bertani H, et al. Endoscopic treatment of gastrointestinal fistulas using an over-the-scope clip (OTSC) device: case series from a tertiary referral center. Endoscopy. 2011;43(6):545–8.PubMedCrossRef Manta R, Manno M, Bertani H, et al. Endoscopic treatment of gastrointestinal fistulas using an over-the-scope clip (OTSC) device: case series from a tertiary referral center. Endoscopy. 2011;43(6):545–8.PubMedCrossRef
13.
Zurück zum Zitat Galizia G, Napolitano V, Castellano P, et al. The Over-The-Scope-Clip (OTSC) system is effective in the treatment of chronic esophagojejunal anastomotic leakage. J Gastrointest Surg. 2012;16(8):1585–9.PubMedCrossRef Galizia G, Napolitano V, Castellano P, et al. The Over-The-Scope-Clip (OTSC) system is effective in the treatment of chronic esophagojejunal anastomotic leakage. J Gastrointest Surg. 2012;16(8):1585–9.PubMedCrossRef
14.
Zurück zum Zitat Disibeyaz S, Seref Köksal A, Parlak E, et al. 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(6):614–21.PubMedCrossRef Disibeyaz S, Seref Köksal A, Parlak E, et al. 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(6):614–21.PubMedCrossRef
15.
Zurück zum Zitat Hagel AF, Naegel A, Lindner AS, et al. Over-the-scope clip application yields a high rate of closure in gastrointestinal perforations and may reduce emergency surgery. J Gastrointest Surg. 2012;16(11):2132–8.PubMedCrossRef Hagel AF, Naegel A, Lindner AS, et al. Over-the-scope clip application yields a high rate of closure in gastrointestinal perforations and may reduce emergency surgery. J Gastrointest Surg. 2012;16(11):2132–8.PubMedCrossRef
16.
Zurück zum Zitat Bona D, Aiolfi A, Rausa E, et al. Management of Boerhaave’s syndrome with an over-the-scope clip. Eur J Cardiothorac Surg. 2014;45(4):752–4.PubMedCrossRef Bona D, Aiolfi A, Rausa E, et al. Management of Boerhaave’s syndrome with an over-the-scope clip. Eur J Cardiothorac Surg. 2014;45(4):752–4.PubMedCrossRef
17.
Zurück zum Zitat Nishiyama N, Mori H, Kobara H, et al. Efficacy and safety of over-the-scope clip: including complications after endoscopic submucosal dissection. World J Gastroenterol. 2013;19(18):2752–60.PubMedCentralPubMedCrossRef Nishiyama N, Mori H, Kobara H, et al. Efficacy and safety of over-the-scope clip: including complications after endoscopic submucosal dissection. World J Gastroenterol. 2013;19(18):2752–60.PubMedCentralPubMedCrossRef
18.
Zurück zum Zitat Mönkemüller K, Peter S, Toshniwal J, et al. Multipurpose use of the ‘bear claw’ (over-the-scope-clip system) to treat endoluminal gastrointestinal disorders. Dig Endosc. 2014;26(3):350–7.PubMedCrossRef Mönkemüller K, Peter S, Toshniwal J, et al. Multipurpose use of the ‘bear claw’ (over-the-scope-clip system) to treat endoluminal gastrointestinal disorders. Dig Endosc. 2014;26(3):350–7.PubMedCrossRef
19.
Zurück zum Zitat Baron TH, Song LM, Ross A, et al. Use of an over-the-scope clipping device: multicenter retrospective results of the first U.S. experience (with videos). Gastrointest Endosc. 2012;76(1):202–8.PubMedCrossRef Baron TH, Song LM, Ross A, et al. Use of an over-the-scope clipping device: multicenter retrospective results of the first U.S. experience (with videos). Gastrointest Endosc. 2012;76(1):202–8.PubMedCrossRef
20.
Zurück zum Zitat Arezzo A., Bullano A., Fischer H., et al. The way to remove an over-the-scope-clip (with video). Gastrointest Endosc. 2013;77(6):974–5.PubMedCrossRef Arezzo A., Bullano A., Fischer H., et al. The way to remove an over-the-scope-clip (with video). Gastrointest Endosc. 2013;77(6):974–5.PubMedCrossRef
Metadaten
Titel
Over-the-scope endoclipping for foregut leaks and perforations
verfasst von
A. Aiolfi
D. Bona
E. Asti
S. Siboni
L. Pogliani
Prof. L. Bonavina
Publikationsdatum
01.08.2014
Verlag
Springer Vienna
Erschienen in
European Surgery / Ausgabe 4/2014
Print ISSN: 1682-8631
Elektronische ISSN: 1682-4016
DOI
https://doi.org/10.1007/s10353-014-0277-5

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