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Over-the-scope clip management of non-acute, full-thickness gastrointestinal defects

  • David J. Morrell
  • Joshua S. Winder
  • Ansh Johri
  • Salvatore Docimo
  • Ryan M. Juza
  • Samantha R. Witte
  • Vamsi V. Alli
  • Eric M. PauliEmail author
2019 SAGES Oral Dynamic

Abstract

Background

Endoscopic management of full-thickness gastrointestinal tract defects (FTGID) has become an attractive management strategy, as it avoids the morbidity of surgery. We have previously described the short-term outcomes of over-the-scope clip management of 22 patients with non-acute FTGID. This study updates our prior findings with a larger sample size and longer follow-up period.

Methods

A retrospective analysis of prospectively collected data was conducted. All patients undergoing over-the-scope clip management of FTGID between 2013 and 2019 were identified. Acute perforations immediately managed and FTGID requiring endoscopic suturing were excluded. Patient demographics, endoscopic adjunct therapies, number of endoscopic interventions, and need for operative management were evaluated. Success was strictly defined as complete FTGID closure.

Results

We identified 92 patients with 117 FTGID (65 fistulae and 52 leaks); 27.2% had more than one FTGID managed simultaneously. The OTSC device (Ovesco Endoscopy, Tubingen, Germany) was utilized in all cases. Additional closure attempts were required in 22.2% of defects. With a median follow-up period of 5.5 months, overall defect closure success rate was 66.1% (55.0% fistulae vs. 79.6% leaks, p = 0.007). There were four mortalities from causes unrelated to the FTGID. Only 14.9% of patients with FTGID underwent operative management. There were no complications related to endoscopic intervention and no patients required urgent surgical intervention.

Conclusions

Over-the-scope clip management of FTGID represents a safe alternative to potentially morbid operative intervention. When strictly defining success as complete closure of all FTGID, endoscopy was successful in 64.4% of patients with only a small minority of patients ultimately requiring surgery.

Keywords

Over-the-scope clip Fistula Leak Endoscopy OTSC 

Notes

Acknowledgements

The authors have no acknowledgements to make.

Funding

No internal or external financial support was used for this report.

Compliance with ethical standards

Disclosures

Eric Pauli receives honoraria and research support from Cook Biotech and C. R. Bard, consultant fees from Boston Scientific and Actuated Medical, and royalties from UpToDate. Salvatore Docimo receives consultant fees from Boston Scientific. David Morrell, Josh Winder, Ansh Johri, Ryan Juza, Samantha Witte, and Vamsi Alli have no conflicts of interest or financial ties to disclose.

Supplementary material

Supplementary material 1 (MP4 141726 kb) Video 1 Endoscopic foreign body removal and irrigation of contaminated peritoneal cavity from staple line leak with endoscopic and fluoroscopic guided placement of percutaneous drain and adjustment of existing percutaneous drain

Supplementary material 2 (MP4 343045 kb) Video 2 Endoscopic closure of FTGID using OTSC clip and OTSC Anchor with endoscopic and fluoroscopic confirmation of successful closure

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • David J. Morrell
    • 1
  • Joshua S. Winder
    • 1
  • Ansh Johri
    • 2
  • Salvatore Docimo
    • 1
  • Ryan M. Juza
    • 1
  • Samantha R. Witte
    • 1
  • Vamsi V. Alli
    • 1
  • Eric M. Pauli
    • 1
    • 3
    Email author
  1. 1.Department of Surgery, Division of Minimally Invasive and Bariatric SurgeryPenn State Health Milton S. Hershey Medical CenterHersheyUSA
  2. 2.Penn State College of MedicineHersheyUSA
  3. 3.Department of Surgery, Division of Minimally Invasive and Bariatric Surgery, College of MedicineThe Pennsylvania State UniversityHersheyUSA

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