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Over-the-Scope Clip Application Yields a High Rate of Closure in Gastrointestinal Perforations and May Reduce Emergency Surgery

  • Original Article
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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Perforation of the gastrointestinal tract may cause various complications and may require emergency surgery, even in patients with significant comorbidities.

Methods

Seventeen consecutive patients with indication for surgery due to a visible gastrointestinal perforation were treated with OTSC application. In this study, cause of perforation, estimated size, location, rate of perforation closure, outcome and complications were reported.

Results

In 11 of 17 patients (64.7 %), OTSC application resulted in permanent closure of perforations, thus avoiding surgery. All 11 successful cases had smaller perforation lengths (5.5 ± 1.9 mm, p < 0.02), widths (3.7 ± 0.9 mm) or area (21.1 ± 9.1 mm2), had vital margins of perforations and 1.1 ± 0.3 OTSC per patient were necessary. The six unsuccessful cases (35.3 %) showed larger perforation lengths (13.4 ± 8.8 mm, p < 0.02), widths (5 ± 4.5 mm) and area (97.6 ± 149 mm2), had necrotic or soft inflammatory margins and significantly more OTSC (2.3 ± 0.5, p = 0.018) were tried.

Conclusions

OTSC application yields a high rate of endoscopic perforation closure in patients with macroscopic gastrointestinal perforation, even in an emergency setting, representing an alternative to surgery, especially when the size of the lesion is not too large and when vital or solid perforation margins are expected.

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Abbreviations

OTSC:

Over-the-scope clip

ESD:

Endoscopic submucosal dissection

EMR:

Endoscopic mucosal resection

NOTES:

Natural orifice transluminal surgery

PEG:

Percutaneous endoscopic gastrostomy

ICU:

Intensive care unit

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Authors and Affiliations

  1. Department of Medicine I, Gastroenterology, University of Erlangen-Nuremberg, Ulmenweg 18, 91054, Erlangen, Germany

    Alexander Fritzkarl Hagel, Andreas Naegel, Annette Simone Lindner, Markus Friedrich Neurath & Martin Raithel

  2. Surgical Department, University of Erlangen–Nuremberg, Erlangen–Nuremberg, Germany

    Hermann Kessler & Klaus Matzel

  3. Harvard Kennedy School of Government, Cambridge, MA, USA

    Wolfgang Dauth

Authors
  1. Alexander Fritzkarl Hagel
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  2. Andreas Naegel
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  3. Annette Simone Lindner
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  4. Hermann Kessler
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  5. Klaus Matzel
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  6. Wolfgang Dauth
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  7. Markus Friedrich Neurath
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  8. Martin Raithel
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Corresponding author

Correspondence to Alexander Fritzkarl Hagel.

Additional information

Take-Home Message

Perforation of the gastrointestinal wall may occur spontaneously during severe diseases, interventional endoscopy or post-operatively. It remains a feared and well-recognised complication, whereby most large visible perforations are usually subjected to surgery.

In a cohort of 17 patients with an estimated visible perforation of 21.1 ± 9 mm2, application of the over-the-scope clip (OTSC) yielded a high rate of perforation closure in 11 of 17 patients (64.7 %) avoiding the need for surgery. The probability of a successful closure decreases with necrotic or inflamed margins, perforation size and the time lapse since perforation. In experienced centers, the use of OTSC may substantially expand the armentarium to treat perforations endoscopically and may lead to avoidance of some emergency surgical interventions, especially in patients with serious co-morbidities.

No grants were obtained for this study.

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Hagel, A.F., Naegel, A., Lindner, A.S. et al. Over-the-Scope Clip Application Yields a High Rate of Closure in Gastrointestinal Perforations and May Reduce Emergency Surgery. J Gastrointest Surg 16, 2132–2138 (2012). https://doi.org/10.1007/s11605-012-1983-6

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  • DOI: https://doi.org/10.1007/s11605-012-1983-6

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