Journal of Gastrointestinal Surgery

, Volume 16, Issue 8, pp 1585–1589 | Cite as

The Over-The-Scope-Clip (OTSC) System is Effective in the Treatment of Chronic Esophagojejunal Anastomotic Leakage

  • Gennaro Galizia
  • Vincenzo Napolitano
  • Paolo Castellano
  • Margherita Pinto
  • Anna Zamboli
  • Pietro Schettino
  • Michele Orditura
  • Ferdinando De Vita
  • Annamaria Auricchio
  • Andrea Mabilia
  • Angelo Pezzullo
  • Eva Lieto
Case Report

Abstract

Introduction

Management of postoperative esophagojejunal anastomotic leakage after total gastrectomy represents a very challenging event. Surgical repair is difficult, and conservative treatment can predispose to more severe complications. Endoclips and self-expanding stents are useful endoscopic therapeutic options but present some drawbacks. The Over-The-Scope-Clip (OTSC) system has been shown to be appropriate to close acute small gastrointestinal perforations, but its use in the treatment of chronic leakage remains controversial.

Case Series

The present series reports three consecutive chronic esophagojejunal anastomotic leaks successfully treated with OTSC. In all cases, clip application was simple, safe and effective, without early and late complications.

Discussion

The OTSC system may represent a new therapeutic option in the management of postoperative esophagojejunal anastomotic leakage.

References

  1. 1.
    Nishikawa K, Yanaga K, Kashiwagi H, Hanyuu N, Iwabuchi S. Significance of intraoperative endoscopy in total gastrectomy for gastric cancer. Surg Endosc 2010;24:2633-2636.PubMedCrossRefGoogle Scholar
  2. 2.
    Fernandez A, Vila JJ, Vazquez S, Gonzalez-Portela C, de la Iglesias M, Lozano M, Toscano E. Self-expanding plastic stents for the treatment of post-operative esophago-jejuno anastomosis leak. A case series study. Rev Esp Enferm Dig 2010;102:704-710.PubMedGoogle Scholar
  3. 3.
    Lieto E, Orditura M, Castellano P, Pinto M, Zamboli A, De Vita F, Pignatelli C, Galizia G. Endoscopic intraoperative anastomotic testing may avoid early gastrointestinal anastomotic complications. A prospective study. J Gastrointest Surg 2011;15:145-152.PubMedCrossRefGoogle Scholar
  4. 4.
    Roy-Choudhury SH, Nicholson AA, Wedgwood KR, Mannion RAJ, Sedman PC, Royston CMS, Breen DJ. Symptomatic malignant gastroesophageal anastomotic leak. Management with covered metallic esophageal stents. AJR 2001;176:161–165.PubMedGoogle Scholar
  5. 5.
    Albert JG, Friedrich-Rust M, Woeste G, Strey C, Bechstein WO, Zeuzem S, Sarrazin C. Benefit of a clipping device in use in intestinal bleeding and intestinal leakage. Gastrointest Endosc 2011;74:389–397.PubMedCrossRefGoogle Scholar
  6. 6.
    Pohl J, Borgulya M, Lorenz D, Ell C. Endoscopic closure of postoperative esophageal leaks with a novel over-the-scope clip system. Endoscopy 2010;42:757–759.PubMedCrossRefGoogle Scholar
  7. 7.
    Kirschniak A, Subotova N, Zieker D, Königsrainer A, Kratt T. The over-the-scope clip (OTSC) for the treatment of gastrointestinal bleeding, perforations, and fistulas. Surg Endosc 2011;25:2901–2905.PubMedCrossRefGoogle Scholar
  8. 8.
    Schurr MO, Hartmann C, Ho CN, Fleisch C, Kirschniak A. An over-the-scope clip (OTSC) system for closure of iatrogenic colon perforations: results of an experimental survival study in pigs. Endoscopy 2008;40:584–588.PubMedCrossRefGoogle Scholar
  9. 9.
    Iacopini F, Di Lorenzo N, Altorio F, Schurr MO, Scozzaro A. Over-the-scope clip closure of two chronic fistulas after gastric band penetration. World J Gastroenterol 2010;16:1665–1669.PubMedCrossRefGoogle Scholar
  10. 10.
    Traina M, Curcio G, Tarantino I, Soresi S, Barresi L, Vitulo P, Gridelli B. New endoscopic over-the-scope clip system for closure of a chronic tracheoesophageal fistula. Endoscopy 2010;42 Suppl 2:E54–55.PubMedCrossRefGoogle Scholar
  11. 11.
    Conio M, Blanchi S, Repici A, Bastardini R, Marinari GM. Use of an over-the-scope clip for endoscopic sealing of a gastric fistula after sleeve gastrectomy. Endoscopy 2010;42 Suppl 2: E71–72.PubMedCrossRefGoogle Scholar
  12. 12.
    Manta R, Manno M, Bertani H, Barbera C, Pigò F, Mirante V, Longinotti E, Bassotti G, Conigliaro R. 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.PubMedCrossRefGoogle Scholar
  13. 13.
    Feith M, Gillen S, Schuster T, Theisen J, Friess H, Gertler R. Healing occurs in most patients that receive endoscopic stents for anastomotic leakage; dislocation remains a problem. Clin Gastroenterol Hepatol 2011; 9:202–210.PubMedCrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2012

Authors and Affiliations

  • Gennaro Galizia
    • 1
  • Vincenzo Napolitano
    • 2
  • Paolo Castellano
    • 1
  • Margherita Pinto
    • 1
  • Anna Zamboli
    • 1
  • Pietro Schettino
    • 2
  • Michele Orditura
    • 3
  • Ferdinando De Vita
    • 3
  • Annamaria Auricchio
    • 1
  • Andrea Mabilia
    • 1
  • Angelo Pezzullo
    • 2
  • Eva Lieto
    • 1
  1. 1.Division of Surgical Oncology—“F. Magrassi–A. Lanzara” Department of Clinical and Experimental Medicine and SurgerySecond University of Naples School of MedicineNaplesItaly
  2. 2.Endoscopy Unit—“F. Magrassi–A. Lanzara” Department of Clinical and Experimental Medicine and SurgerySecond University of Naples School of MedicineNaplesItaly
  3. 3.Division of Medical Oncology—“F. Magrassi–A. Lanzara” Department of Clinical and Experimental Medicine and SurgerySecond University of Naples School of MedicineNaplesItaly

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