Skip to main content

Advertisement

SpringerLink
Log in

Management of non-acute gastrointestinal defects using the over-the-scope clips (OTSCs): a retrospective single-institution experience

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Introduction

Advanced endoscopic techniques provide novel therapies for complications historically treated with surgical interventions. Over-the-scope clips (OTSCs) have recently been shown to be effective at endoscopic closure of gastrointestinal (GI) defects. We hypothesize that by following classic surgical principles of fistula management, a high rate of long-term success can be achieved with endoscopic closure of non-acute GI tract defects.

Methods

A retrospective review of a single-institution prospectively maintained database (2012–2015) of all patients referred for the management of GI leaks or fistulae who underwent attempted closure with the OTSC system (Ovesco, Germany) was performed. Acute perforations were excluded. The primary endpoint was long-term success defined by the absence of radiographic or clinical evidence of leak or fistula during follow-up. Patients were stratified by success or failure of OTSC closure and compared with Fisher’s exact and Mann–Whitney U tests.

Results

We identified 22 patients with 28 defects (22 fistulae and 6 leaks). Most patients were female (59 %) with a mean age of 54 years (±14), median BMI of 29, and prior bariatric procedure (55 %). Comorbidities included smoking history (68 %) and diabetes (23 %). The majority of defects were solitary (64 %), involved the upper GI tract (82 %), and had been present for >30 days (50 %). Multiple therapeutic interventions were necessary in 46 % of defects. There were no adverse outcomes related to OTSC placement or misfiring. Endoscopic adjuncts were used in 61 % of cases. Overall success rate was 82 % (100 % for leaks and 76 % for fistulae) at a median follow-up of 4.7 months (IQR 2.1–8.4 months). Predictors of success and failure could not be distinguished due to limited sample size.

Conclusions

Over-the-scope clips can be safely and effectively used in patients presenting with GI leaks and fistulae. Further research is required to characterize the determinants of long-term success and risk factors for failure.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Almahmeed T, Gonzalez R, Nelson LG, Haines K, Gallagher SF, Murr MM (2007) Morbidity of anastomotic leaks in patients undergoing Roux-en-Y gastric bypass. Arch Surg 142(10):954–957. doi:10.1001/archsurg.142.10.954

    Article  PubMed  Google Scholar 

  2. Alanezi K, Urschel JD (2004) Mortality secondary to esophageal anastomotic leak. Ann Thorac Cardiovasc Surg 10(2):71–75

    PubMed  Google Scholar 

  3. Luning TH, Keemers-Gels ME, Barendregt WB, Tan AC, Rosman C (2007) Colonoscopic perforations: a review of 30,366 patients. Surg Endosc 21(6):994–997. doi:10.1007/s00464-007-9251-7

    Article  CAS  PubMed  Google Scholar 

  4. Svanes C (2000) Trends in perforated peptic ulcer: incidence, etiology, treatment, and prognosis. World J Surg 24(3):277–283

    Article  CAS  PubMed  Google Scholar 

  5. Juza RM, Haluck RS, Pauli EM, Rogers AM, Won EJ, LynSue JR (2015) Gastric sleeve leak: a single institution’s experience with early combined laparoendoscopic management. Surg Obes Relat Dis 11(1):60–64. doi:10.1016/j.soard.2014.06.011

    Article  PubMed  Google Scholar 

  6. Pauli EM, Beshir H, Mathew A (2014) Gastrogastric fistulae following gastric bypass surgery-clinical recognition and treatment. Curr Gastroenterol Rep 16(9):405. doi:10.1007/s11894-014-0405-1

    Article  PubMed  Google Scholar 

  7. Al Ghossaini N, Lucidarme D, Bulois P (2014) Endoscopic treatment of iatrogenic gastrointestinal perforations: an overview. Dig Liver Dis 46(3):195–203. doi:10.1016/j.dld.2013.09.024

    Article  PubMed  Google Scholar 

  8. Kouklakis G, Zezos P, Liratzopoulos N, Gatopoulou A, Oikonomou A, Pitiakoudis M, Efremidou E, Simopoulos C (2011) Endoscopic treatment of a gastrocutaneous fistula using the over-the-scope-clip system: a case report. Diagn Ther Endosc 2011:384143. doi:10.1155/2011/384143

    Article  PubMed  PubMed Central  Google Scholar 

  9. Lee WC, Ko WJ, Cho JH, Lee TH, Jeon SR, Kim HG, Cho JY (2014) Endoscopic treatment of various gastrointestinal tract defects with an over-the-scope clip: case series from a tertiary referral hospital. Clin Endosc 47(2):178–182. doi:10.5946/ce.2014.47.2.178

    Article  PubMed  PubMed Central  Google Scholar 

  10. Manta R, Manno M, Bertani H, Barbera C, Pigo F, Mirante V, Longinotti E, Bassotti G, Conigliaro R (2011) Endoscopic treatment of gastrointestinal fistulas using an over-the-scope clip (OTSC) device: case series from a tertiary referral center. Endoscopy 43(6):545–548. doi:10.1055/s-0030-1256196

    Article  CAS  PubMed  Google Scholar 

  11. Mennigen R, Colombo-Benkmann M, Senninger N, Laukoetter M (2013) Endoscopic closure of postoperative gastrointestinal leakages and fistulas with the Over-the-Scope Clip (OTSC). J Gastrointest Surg 17(6):1058–1065. doi:10.1007/s11605-013-2156-y

    Article  PubMed  Google Scholar 

  12. Mercky P, Gonzalez JM, Aimore Bonin E, Emungania O, Brunet J, Grimaud JC, Barthet M (2015) Usefulness of over-the-scope clipping system for closing digestive fistulas. Dig Endosc 27(1):18–24. doi:10.1111/den.12295

    Article  PubMed  Google Scholar 

  13. Haito-Chavez Y, Law JK, Kratt T, Arezzo A, Verra M, Morino M, Sharaiha RZ, Poley JW, Kahaleh M, Thompson CC, Ryan MB, Choksi N, Elmunzer BJ, Gosain S, Goldberg EM, Modayil RJ, Stavropoulos SN, Schembre DB, DiMaio CJ, Chandrasekhara V, Hasan MK, Varadarajulu S, Hawes R, Gomez V, Woodward TA, Rubel-Cohen S, Fluxa F, Vleggaar FP, Akshintala VS, Raju GS, Khashab MA (2014) International multicenter experience with an over-the-scope clipping device for endoscopic management of GI defects (with video). Gastrointest Endosc 80(4):610–622. doi:10.1016/j.gie.2014.03.049

    Article  PubMed  Google Scholar 

  14. Committee AT, Banerjee S, Barth BA, Bhat YM, Desilets DJ, Gottlieb KT, Maple JT, Pfau PR, Pleskow DK, Siddiqui UD, Tokar JL, Wang A, Song LM, Rodriguez SA (2012) Endoscopic closure devices. Gastrointest Endosc 76(2):244–251. doi:10.1016/j.gie.2012.02.028

    Article  Google Scholar 

  15. Csendes A, Braghetto I, Leon P, Burgos AM (2010) Management of leaks after laparoscopic sleeve gastrectomy in patients with obesity. J Gastrointest surg 14(9):1343–1348. doi:10.1007/s11605-010-1249-0

    Article  PubMed  Google Scholar 

  16. von Renteln D, Denzer UW, Schachschal G, Anders M, Groth S, Rosch T (2010) Endoscopic closure of GI fistulae by using an over-the-scope clip (with videos). Gastrointest Endosc 72(6):1289–1296. doi:10.1016/j.gie.2010.07.033

    Article  Google Scholar 

  17. Zolotarevsky E, Kwon Y, Bains M, Schattner M (2012) Esophagobronchial fistula closure using a novel endoscopic over-the-scope-clip. Ann Thorac Surg 94(3):e69–e70. doi:10.1016/j.athoracsur.2012.02.025

    Article  PubMed  Google Scholar 

  18. Schmidt A, Riecken B, Damm M, Cahyadi O, Bauder M, Caca K (2014) Endoscopic removal of over-the-scope clips using a novel cutting device: a retrospective case series. Endoscopy 46(9):762–766. doi:10.1055/s-0034-1365493

    Article  PubMed  Google Scholar 

Download references

Funding source

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

Author information

Authors and Affiliations

  1. Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA

    Joshua S. Winder MD, Afif N. Kulaylat MD, Jane R. Schubart PhD & Eric M. Pauli MD

  2. Department of Radiology, The Pennsylvania State University, College of Medicine, Hershey, PA, USA

    Hassan M. Hal MD

Authors
  1. Joshua S. Winder MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Afif N. Kulaylat MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jane R. Schubart PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hassan M. Hal MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Eric M. Pauli MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eric M. Pauli MD.

Ethics declarations

Disclosures

Joshua S. Winder, Afif N. Kulaylat, Jane R. Schubart, and Hassan M. Hal have no conflicts of interest financial affiliations to disclose. Eric M. Pauli receives honoraria for teaching and research from Cook Biotech.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Winder, J.S., Kulaylat, A.N., Schubart, J.R. et al. Management of non-acute gastrointestinal defects using the over-the-scope clips (OTSCs): a retrospective single-institution experience. Surg Endosc 30, 2251–2258 (2016). https://doi.org/10.1007/s00464-015-4500-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-015-4500-7

Keywords

Search

Navigation