Abstract
Background
In contrast to conventional Through-the-Scope Clips, the novel Over-the-Scope Clip (OTSC®) allows endoscopic full thickness closure of gastrointestinal leakages. The purpose of this study was to evaluate the efficacy and safety of the OTSC for the management of postoperative gastrointestinal leakages and fistulas.
Methods
We retrospectively reviewed a series of 14 consecutive patients with postoperative gastrointestinal leakages and fistulas who were treated by OTSC application.
Results
Nine OTSCs were used for upper GI tract leakages; five were used for colorectal leakages. Seventy-nine percent (11/14) of leakages were chronic (treated by OTSC later than postoperative day 14). In nine patients, other therapies preceded OTSC application. Median follow-up time was 5.5 months (range, 0.25–17). Primary technical success was achieved in all (14/14) patients. No adverse events related to the use of the OTSC device were noted. Three early recurrences were observed (two colonic fistulas, one esophageal anastomotic leakage), leading to a long-term success rate of 79 % (11/14). Leakage closure finally was achieved in these three patients by surgery or endoscopic vacuum therapy.
Conclusions
The OTSC system is an effective and safe method for the management of postoperative leakages and fistulas of the gastrointestinal tract. Its exact place in treatment algorithms of postoperative leakages will have to be determined.
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References
Blencowe NS, Strong S, McNair AG, Brookes ST, Crosby T, Griffin SM, Blazeby JM. Reporting of short-term clinical outcomes after esophagectomy: a systematic review. Ann Surg 2012;255:658–666.
Huser N, Michalski CW, Erkan M, Schuster T, Rosenberg R, Kleeff J, Friess H. Systematic review and meta-analysis of the role of defunctioning stoma in low rectal cancer surgery. Ann Surg 2008;248:52–60.
van Boeckel PG, Sijbring A, Vleggaar FP, Siersema PD. Systematic review: temporary stent placement for benign rupture or anastomotic leak of the oesophagus. Aliment Pharmacol Ther 2011;33:1292–1301.
Tuebergen D, Rijcken E, Mennigen R, Hopkins AM, Senninger N, Bruewer M. Treatment of thoracic esophageal anastomotic leaks and esophageal perforations with endoluminal stents: efficacy and current limitations. J Gastrointest Surg 2008;12:1168–1176.
Yoshikane H, Hidano H, Sakakibara A, Ayakawa T, Mori S, Kawashima H, Goto H, Niwa Y. Endoscopic repair by clipping of iatrogenic colonic perforation. Gastrointest Endosc 1997;46:464–466.
Rodella L, Laterza E, De Manzoni G, Kind R, Lombardo F, Catalano F, Ricci F, Cordiano C. Endoscopic clipping of anastomotic leakages in esophagogastric surgery. Endoscopy 1998;30:453–456.
Kirschniak A, Kratt T, Stuker D, Braun A, Schurr MO, Konigsrainer A. A new endoscopic over-the-scope clip system for treatment of lesions and bleeding in the GI tract: first clinical experiences. Gastrointest Endosc 2007;66:162–167.
Sodergren MH, Coomber R, Clark J, Karimyan V, Athanasiou T, Teare J, Yang GZ, Darzi A. What are the elements of safe gastrotomy closure in NOTES? A systematic review. Surg Innov 2010;17:318–331.
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.
Arezzo A, Verra M, Reddavid R, Cravero F, Bonino MA, Morino M. Efficacy of the over-the-scope clip (OTSC) for treatment of colorectal postsurgical leaks and fistulas. Surg Endosc 2012;26:3330–3333.
Disibeyaz S, Koksal AS, Parlak E, Torun S, Sasmaz N. Endoscopic closure of gastrointestinal defects with an over-the-scope clip device. A case series and review of the literature. Clin Res Hepatol Gastroenterol 2012;36:614–621.
Galizia G, Napolitano V, Castellano P, Pinto M, Zamboli A, Schettino P, Orditura M, De Vita F, Auricchio A, Mabilia A, Pezzullo A, Lieto E. The over-the-scope-clip (OTSC) system is effective in the treatment of chronic esophagojejunal anastomotic leakage. J Gastrointest Surg 2012;16:1585–1589.
Gubler C, Bauerfeind P. Endoscopic closure of iatrogenic gastrointestinal tract perforations with the over-the-scope clip. Digestion 2012;85:302–307.
Hagel AF, Naegel A, Lindner AS, Kessler H, Matzel K, Dauth W, Neurath MF, Raithel M. Over-the-scope clip application yields a high rate of closure in gastrointestinal perforations and may reduce emergency surgery. J Gastrointest Surg 2012;16:2132–2138.
Kirschniak A, Subotova N, Zieker D, Konigsrainer A, Kratt T. The over-the-scope clip (OTSC) for the treatment of gastrointestinal bleeding, perforations, and fistulas. Surg Endosc 2011;25:2901–2905.
Manta R, Manno M, Bertani H, Barbera C, Pigo 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.
Parodi A, Repici A, Pedroni A, Blanchi S, Conio M. Endoscopic management of GI perforations with a new over-the-scope clip device (with videos). Gastrointest Endosc 2010;72:881–886.
Seebach L, Bauerfeind P, Gubler C. “Sparing the surgeon”: clinical experience with over-the-scope clips for gastrointestinal perforation. Endoscopy 2010;42:1108–1111.
von Renteln D, Denzer UW, Schachschal G, Anders M, Groth S, Rosch T. Endoscopic closure of GI fistulae by using an over-the-scope clip (with videos). Gastrointest Endosc 2010;72:1289–1296.
Voermans RP, Le Moine O, von Renteln D, Ponchon T, Giovannini M, Bruno M, Weusten B, Seewald S, Costamagna G, Deprez P, Fockens P. Efficacy of endoscopic closure of acute perforations of the gastrointestinal tract. Clin Gastroenterol Hepatol 2012;10:603–608.
Fahndrich M, Sandmann M, Heike M. Removal of over the scope clips (OTSC) with an Nd:YAG Laser. Z Gastroenterol 2011;49:579–583.
Disclosures
Drs. Mennigen, Colombo-Benkmann, Senninger, and Laukoetter have no conflicts of interest or financial ties to disclose.
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There was no funding for this study.
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Mennigen, R., Colombo-Benkmann, M., Senninger, N. et al. Endoscopic Closure of Postoperative Gastrointestinal Leakages and Fistulas with the Over-the-Scope Clip (OTSC). J Gastrointest Surg 17, 1058–1065 (2013). https://doi.org/10.1007/s11605-013-2156-y
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DOI: https://doi.org/10.1007/s11605-013-2156-y