Case study
Endoscopic management of GI perforations with a new over-the-scope clip device (with videos)

https://doi.org/10.1016/j.gie.2010.04.006Get rights and content

Background

Through-the-scope endoclips have been used to manage small perforations in the GI tract, but they have limitations. A new over-the-scope clip system, OTSC (Ovesco Endoscopy, Tuebingen, Germany), may be suitable for the closure of larger GI leaks.

Objective

To evaluate the clinical outcomes of patients with GI perforations of up to 20 mm, treated with OTSC.

Design

Prospective, single-arm, pilot study.

Setting

General hospitals referral centers for endotherapy.

Patients

This study involved 10 patients (median age 58.5 years [range 27-82 years], 7 men) with GI leaks from perforations, fistulas, and anastomotic dehiscence. Two gastric, 2 duodenal, and 6 colonic leaks were treated with OTSC. The diameter of leaks ranged between 7 and 20 mm.

Interventions

OTSC devices were used to seal the GI leaks. Then Gastrografin (Bayer AG, Germany) was introduced via the endoscope and complete sealing confirmed under fluoroscopy. Patients underwent a second endoscopic examination 3 months later.

Main Outcome Measurement

Complete sealing of the leak.

Results

Complete sealing of leaks was achieved by using OTSC alone in 8 of 10 patients. For one patient, successful endoscopic management was completed by placing two additional covered stents. Only one patient required surgical repair of the leak. Endoscopic examination 3 months after treatment confirmed that leaks in 8 of 9 endoscopically treated patients were healed, and the patients did not have recurrence of the leaks or complications from the OTSC devices. One patient died from neoplastic progression before the second endoscopy could be performed.

Limitations

Uncontrolled study.

Conclusions

The OTSC system appears to be a useful device in the management of larger GI leaks in a variety of clinical scenarios.

Section snippets

Over-the-scope clip device

The OTSC system is mounted onto the tip of a high-definition gastroscope (Olympus GIF-H180; diameter of 9.8 mm; working channel of 2.8 mm; Olympus, Tokyo, Japan) in the same manner as a band ligator device. In this study we used the “traumatic” version of OTSC, which has pointed teeth (10.5-12.0 mm). The clip is preloaded into the applicator cap in an open state. The OTSC consists of a shape-memory nitinol alloy, which returns to its initial shape when it is released from the applicator,

Results

Seven of 10 patients were male (median age 58.5 years, range 27-82 years). Patient characteristics and outcomes are summarized in Table 1.

Discussion

In the past, the treatment of GI leaks resulting from perforations, fistulas, or anastomotic dehiscence was primarily surgical. Surgical intervention for large-bowel perforation has a mortality rate of up to 8.6%.12 Emergency surgery for perforated gastroduodenal ulcers has a mortality rate ranging from 5% to 30%.13, 14 The advancement of endotherapy in the GI tract requires techniques for safe and effective control of complications. Through-the-scope clips have been used in some clinical

Disclosure

All authors disclosed no financial relationships relevant to this publication.

Acknowledgment

The authors are grateful to Deborah A. Fisher, MD, MHS, Division of Gastroenterology, Duke University Medical Center, Durham, North Carolina, for her assistance in revising the manuscript.

References (22)

Cited by (151)

  • Endoscopic Therapy for Fistulas and Abscesses in Crohn's Disease

    2022, Gastrointestinal Endoscopy Clinics of North America
  • Use of the Over the Scope Clip to Close Perforations and Fistulas

    2020, Gastrointestinal Endoscopy Clinics of North America
  • Endoscopic management of iatrogenic gastrointestinal perforations

    2019, Laparoscopic, Endoscopic, and Robotic Surgery
    Citation Excerpt :

    Over the scope clip (OTSC) system is an ideal alternative of surgery for large IP. It was first approved by the Food and Drug Administration of the United States in 2010 for endoscopic gastrointestinal wall closure and hemostatsis.45 OTSC is made of nitinol alloy and equipped at the distal end of the endoscope with a transparent cap.

View all citing articles on Scopus
View full text