Skip to main content

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

Journal of Gastrointestinal Surgery volume 16, pages 1585–1589 (2012)Cite this article

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.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3

References

  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.

    PubMed  Article  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  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.

    PubMed  Article  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  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.

    PubMed  Article  Google Scholar 

  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.

    PubMed  Article  CAS  Google Scholar 

  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.

    PubMed  Article  Google Scholar 

  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.

    PubMed  Article  CAS  Google Scholar 

  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.

    PubMed  Article  Google Scholar 

  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.

    PubMed  Article  Google Scholar 

  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.

    PubMed  Article  Google Scholar 

  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.

    PubMed  Article  CAS  Google Scholar 

  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.

    PubMed  Article  Google Scholar 

Download references

Author information

Affiliations

  1. Division of Surgical Oncology—“F. Magrassi–A. Lanzara” Department of Clinical and Experimental Medicine and Surgery, Second University of Naples School of Medicine, c/o II Policlinico, Edificio 17, Via Pansini, 5, 80131, Naples, Italy

    Gennaro Galizia, Paolo Castellano, Margherita Pinto, Anna Zamboli, Annamaria Auricchio, Andrea Mabilia & Eva Lieto

  2. Endoscopy Unit—“F. Magrassi–A. Lanzara” Department of Clinical and Experimental Medicine and Surgery, Second University of Naples School of Medicine, Naples, Italy

    Vincenzo Napolitano, Pietro Schettino & Angelo Pezzullo

  3. Division of Medical Oncology—“F. Magrassi–A. Lanzara” Department of Clinical and Experimental Medicine and Surgery, Second University of Naples School of Medicine, Naples, Italy

    Michele Orditura & Ferdinando De Vita

Authors
  1. Gennaro Galizia
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vincenzo Napolitano
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Paolo Castellano
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Margherita Pinto
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Anna Zamboli
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Pietro Schettino
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Michele Orditura
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ferdinando De Vita
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Annamaria Auricchio
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Andrea Mabilia
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Angelo Pezzullo
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Eva Lieto
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gennaro Galizia.

Additional information

Gennaro Galizia MD Ph.D. and Vincenzo Napolitano M.D. contributed equally to this work.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

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 16, 1585–1589 (2012). https://doi.org/10.1007/s11605-012-1862-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-012-1862-1

Keywords

  • Endoscopic Mucosal Resection
  • Wall Defect
  • Gastrografin
  • Clinical Leakage
  • Esophagojejunal Anastomosis