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Outcome, comorbidity, hospitalization and 30-day mortality after closure of acute perforations and postoperative anastomotic leaks by the over-the-scope clip (OTSC) in an unselected cohort of patients

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Abstract

Background

Acute gastrointestinal (GI) wall defects contain a high risk of morbidity and mortality and may be closed endoscopically by a full-thickness over-the-scope clip (OTSC).

Methods

Unselected consecutive patients presenting with acute non-surgical perforations or postoperative anastomotic leaks or perforations underwent attempted OTSC placement as primary closure method after interdisciplinary consensus in three tertiary referral centres. Their clinical data and intervention characteristics were evaluated in an intention to treat analysis during a 24-month period to assess closure rates, 30-day mortality, hospitalization and comorbidity.

Results

In total, 34 patients (16 females, 18 males, 69.5 years) were included with 22 non-surgical perforations and 12 postoperative anastomotic leaks or perforations. Definitive closure of the perforations and leaks was achieved in 26/34 patients (76.5 %). Successful closure of the GI wall defect resulted in a significantly shorter hospital stay (8 days, p = 0.03) and was significantly correlated with comorbidity (r = 0.56, p = 0.005). In the group with OTSC failure, hospitalization was 18 days and 6 of 8 patients (75 %) required immediate surgery. Three deaths occurred in the group with successful OTSC closure due to comorbidity, while one death in the OTSC failure group was related to a refractory perforation. Favourable indications and locations for a successful OTSC procedure were identified as PEG complications, endoscopic or postoperative leaks of stomach, colon or rectum, respectively.

Conclusions

In unselected patients, OTSC was effective for closure of acute GI wall defects in more than 75 % of all patients. Clinical success and short hospitalization were best achieved in patients without comorbidity, but closure of the perforation or the anastomotic leak was found to be not the only parameter relevant for patient outcome and mortality.

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Abbreviations

GI:

Gastrointestinal

GIT:

Gastrointestinal tract

PEG:

Percutaneous endoscopic gastrostomy

OTSC:

Over-the-scope clip

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Authors and Affiliations

  1. Department of Medicine II, Gastroenterology and Interventional Endoscopy, Waldkrankenhaus St. Marien, Erlangen, Germany

    M. Raithel

  2. Department of Medicine 1, Gastroenterology, University Erlangen, Erlangen, Germany

    H. Albrecht, A. F. Hagel, F. Vitali & M. F. Neurath

  3. Internal Medicine and Gastroenterology, Julius-Spital, Würzburg, Germany

    W. Scheppach

  4. Internal Medicine and Gastroenterology, Clinics, Fürth, Germany

    M. Farnbacher & H. T. Schneider

  5. Gastroenterology Practice, Erlangen, Germany

    M. Farnbacher

  6. Surgical Department, University Erlangen, Erlangen, Germany

    W. Haupt & V. Schellerer

Authors
  1. M. Raithel
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  2. H. Albrecht
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  6. A. F. Hagel
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  8. F. Vitali
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  9. M. F. Neurath
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Correspondence to M. Raithel.

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Disclosures

M. Neurath reports personal fees from MSD Sharp and Dohme GmbH, personal fees from PPM Services S.A., personal fees from Index Pharmaceuticals AB, personal fees from Shire GmbH, personal fees from Boehringer Ingelheim GmbH & Co. KG, personal fees from Janssen Cilag GmbH, personal fees from Pentax Europe GmbH, personal fees from Tillotts Pharma AG, personal fees from e.Bavarian Health GmbH, personal fees from Takeda Pharma GmbH, grants from German Research Council, grants from German Cancer Aid, outside the submitted work, In addition, Dr. Neurath has a patent Anti-IL 12 therapy in Crohn’s Disease issued. M Raithel, H. Albrecht, W. Scheppach, M. Farnbacher, W. Haupt, A. Hagel, V. Schellerer, F. Vitali, H. Schneider have nothing to disclose.

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Raithel, M., Albrecht, H., Scheppach, W. et al. Outcome, comorbidity, hospitalization and 30-day mortality after closure of acute perforations and postoperative anastomotic leaks by the over-the-scope clip (OTSC) in an unselected cohort of patients. Surg Endosc 31, 2411–2425 (2017). https://doi.org/10.1007/s00464-016-5242-x

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