Top

Surgical Endoscopy

Published in:

01-06-2016

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

Authors: Joshua S. Winder, MD, Afif N. Kulaylat, MD, Jane R. Schubart, PhD, Hassan M. Hal, MD, Eric M. Pauli, MD

Published in: Surgical Endoscopy | Issue 6/2016

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.

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 CrossRefPubMed

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

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 CrossRefPubMed

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

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMedPubMedCentral

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 CrossRefPubMedPubMedCentral

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRef

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 CrossRefPubMed

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 CrossRef

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 CrossRefPubMed

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 CrossRefPubMed

Title: Management of non-acute gastrointestinal defects using the over-the-scope clips (OTSCs): a retrospective single-institution experience
Authors: Joshua S. Winder, MD
Afif N. Kulaylat, MD
Jane R. Schubart, PhD
Hassan M. Hal, MD
Eric M. Pauli, MD
Publication date: 01-06-2016
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 6/2016
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-015-4500-7

At a glance: The STEP trials

Springer Medicine

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

Abstract

Introduction

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 6/2016

Safety analysis of primary bariatric surgery in patients on chronic dialysis

Single-stage revision from gastric band to gastric bypass or sleeve gastrectomy: 6- and 12-month outcomes

Minimally invasive surgery versus percutaneous radio frequency ablation for the treatment of single small (≤3 cm) hepatocellular carcinoma: a case–control study

Early hospital readmission after bariatric surgery

Intestinal microbiota and anastomotic leakage of stapled colorectal anastomoses: a pilot study

The combined effect of age and body mass index on outcomes in foregut surgery: a regression model analysis of the National Surgical Quality Improvement Program data