Skip to main content
Top
Published in: Surgical Endoscopy 12/2019

01-12-2019

Over-the-scope-clip applications for perforated peptic ulcer

Authors: Jing-Jing Wei, Xue-Ping Xie, Ting-Ting Lian, Zhi-Yong Yang, Yu-Feng Pan, Zhen-Lv Lin, Guang-Wei Zheng, Ze-Hao Zhuang

Published in: Surgical Endoscopy | Issue 12/2019

Login to get access

Abstract

Aim

To investigate the effectiveness of over-the-scope-clip (OTSC)-based endoscopic closure in patients with perforated peptic ulcer (PPU).

Methods

One hundred six patients diagnosed with PPU were treated with either OTSC (n = 26) or conservative treatments (n = 80), respectively. The outcome assessments included technical success rate, clinical success rate, post-treatment complications after 1 month, mortality rate, time to resume oral feeding, length of hospital stay, and the administration of antibiotics.

Results

In the OTSC group, technical and clinical success was achieved in 100% of patients without any complications, including death, incomplete closure, duodenal obstruction, and gastrointestinal bleeding, with a median operation time of 10 min. All patients in the OTSC group were discharged, while the mortality rate in the control group was 13.8%. Subsequent surgeries were required in 30% of patients in the control group. The median times to resume oral feeding were 3.5 (interquartile range [IQR] 2.0–5.25) days in the OTSC group and 7.0 (IQR 5.0–9.0) days in the control group (p < 0.001). One month post-procedure, 30% (24/80) of patients in the control group and 0 (0/26) in the OTSC group required additional operations (p < 0.001). No significant difference was found in the length of the hospital stay and the administration of antibiotics between the two groups (p > 0.05).

Conclusions

OTSC-based endoscopic technique, with a high clinical success rate and a shorter time to resume oral feeding, was effective in achieving closure of PPU with a diameter < 15 mm.
Literature
1.
go back to reference Haito-Chavez Y, Law JK, Kratt T et al (2014) International multicenter experience with an over-the-scope clipping device for endoscopic management of GI defects (with video). Gastrointest Endosc 80(4):610–622CrossRef Haito-Chavez Y, Law JK, Kratt T et al (2014) International multicenter experience with an over-the-scope clipping device for endoscopic management of GI defects (with video). Gastrointest Endosc 80(4):610–622CrossRef
2.
go back to reference Verlaan T, Voermans RP, van Berge Henegouwen MI et al (2015) Endoscopic closure of acute perforations of the GI tract: a systematic review of the literature. Gastrointest Endosc 82(4):618–628 e5CrossRef Verlaan T, Voermans RP, van Berge Henegouwen MI et al (2015) Endoscopic closure of acute perforations of the GI tract: a systematic review of the literature. Gastrointest Endosc 82(4):618–628 e5CrossRef
3.
go back to reference von Renteln D, Rudolph HU, Schmidt A et al (2010) Endoscopic closure of duodenal perforations by using an over-the-scope clip: a randomized, controlled porcine study. Gastrointest Endosc 71(1):131–138CrossRef von Renteln D, Rudolph HU, Schmidt A et al (2010) Endoscopic closure of duodenal perforations by using an over-the-scope clip: a randomized, controlled porcine study. Gastrointest Endosc 71(1):131–138CrossRef
4.
go back to reference Iabichino G, Eusebi LH, Palamara MA et al (2018) Performance of the over-the-scope clip system in the endoscopic closure of iatrogenic gastrointestinal perforations and post-surgical leaks and fistulas. Minerva Gastroenterol Dietol 64(1):75–83PubMed Iabichino G, Eusebi LH, Palamara MA et al (2018) Performance of the over-the-scope clip system in the endoscopic closure of iatrogenic gastrointestinal perforations and post-surgical leaks and fistulas. Minerva Gastroenterol Dietol 64(1):75–83PubMed
5.
go back to reference Changela K, Virk MA, Patel N et al (2014) Role of over the scope clips in the management of iatrogenic gastrointestinal perforations. World J Gastroenterol 20(32):11460–11462CrossRef Changela K, Virk MA, Patel N et al (2014) Role of over the scope clips in the management of iatrogenic gastrointestinal perforations. World J Gastroenterol 20(32):11460–11462CrossRef
6.
go back to reference Dellon ES, Hawk JS, Grimm IS et al (2009) The use of carbon dioxide for insufflation during GI endoscopy: a systematic review. Gastrointest Endosc 69(4):843–849CrossRef Dellon ES, Hawk JS, Grimm IS et al (2009) The use of carbon dioxide for insufflation during GI endoscopy: a systematic review. Gastrointest Endosc 69(4):843–849CrossRef
7.
go back to reference Sumanac K, Zealley I, Fox BM et al (2002) Minimizing postcolonoscopy abdominal pain by using CO(2) insufflation: a prospective, randomized, double blind, controlled trial evaluating a new commercially available CO(2) delivery system. Gastrointest Endosc 56(2):190–194CrossRef Sumanac K, Zealley I, Fox BM et al (2002) Minimizing postcolonoscopy abdominal pain by using CO(2) insufflation: a prospective, randomized, double blind, controlled trial evaluating a new commercially available CO(2) delivery system. Gastrointest Endosc 56(2):190–194CrossRef
8.
go back to reference Saito Y, Uraoka T, Matsuda T et al (2007) A pilot study to assess the safety and efficacy of carbon dioxide insufflation during colorectal endoscopic submucosal dissection with the patient under conscious sedation. Gastrointest Endosc 65(3):537–542CrossRef Saito Y, Uraoka T, Matsuda T et al (2007) A pilot study to assess the safety and efficacy of carbon dioxide insufflation during colorectal endoscopic submucosal dissection with the patient under conscious sedation. Gastrointest Endosc 65(3):537–542CrossRef
9.
go back to reference Montalvo-Javé EE, Corres-Sillas O, Athié-Gutiérrez C (2011) Factors associated with postoperative complications and mortality in perforated peptic ulcer. Cir Cir 79(2):141–148PubMed Montalvo-Javé EE, Corres-Sillas O, Athié-Gutiérrez C (2011) Factors associated with postoperative complications and mortality in perforated peptic ulcer. Cir Cir 79(2):141–148PubMed
10.
go back to reference Boey J, Choi SK, Poon A et al (1987) Risk stratification in perforated duodenal ulcers. A prospective validation of predictive factors. Ann Surg 205(1):22–26CrossRef Boey J, Choi SK, Poon A et al (1987) Risk stratification in perforated duodenal ulcers. A prospective validation of predictive factors. Ann Surg 205(1):22–26CrossRef
11.
go back to reference Billing A, Fröhlich D, Schildberg FW (1994) Prediction of outcome using the Mannheim peritonitis index in 2003 patients. Peritonitis Study Group. Br J Surg 81(2):209–213CrossRef Billing A, Fröhlich D, Schildberg FW (1994) Prediction of outcome using the Mannheim peritonitis index in 2003 patients. Peritonitis Study Group. Br J Surg 81(2):209–213CrossRef
12.
go back to reference Thorsen K, Glomsaker TB, von Meer A et al (2011) Trends in diagnosis and surgical management of patients with perforated peptic ulcer. J Gastrointest Surg 15(8):1329–1335CrossRef Thorsen K, Glomsaker TB, von Meer A et al (2011) Trends in diagnosis and surgical management of patients with perforated peptic ulcer. J Gastrointest Surg 15(8):1329–1335CrossRef
13.
go back to reference Thorsen K, Søreide JA, Søreide K (2014) What is the best predictor of mortality in perforated peptic ulcer disease? A population-based, multivariable regression analysis including three clinical scoring systems. J Gastrointest Surg 18(7):1261–1268CrossRef Thorsen K, Søreide JA, Søreide K (2014) What is the best predictor of mortality in perforated peptic ulcer disease? A population-based, multivariable regression analysis including three clinical scoring systems. J Gastrointest Surg 18(7):1261–1268CrossRef
14.
go back to reference Muller MK, Wrann S, Widmer J et al (2016) Perforated peptic ulcer repair: factors predicting conversion in laparoscopy and postoperative septic complications. World J Surg 40(9):2186–2193CrossRef Muller MK, Wrann S, Widmer J et al (2016) Perforated peptic ulcer repair: factors predicting conversion in laparoscopy and postoperative septic complications. World J Surg 40(9):2186–2193CrossRef
15.
go back to reference Bertleff MJ, Lange JF (2010) Laparoscopic correction of perforated peptic ulcer: first choice? A review of literature. Surg Endosc 24(6):1231–1239CrossRef Bertleff MJ, Lange JF (2010) Laparoscopic correction of perforated peptic ulcer: first choice? A review of literature. Surg Endosc 24(6):1231–1239CrossRef
16.
go back to reference Tas I, Ulger BV, Onder A et al (2014) Risk factors influencing morbidity and mortality in perforated peptic ulcer disease. Ulus Cerrahi Derg 31(1):20–25PubMedPubMedCentral Tas I, Ulger BV, Onder A et al (2014) Risk factors influencing morbidity and mortality in perforated peptic ulcer disease. Ulus Cerrahi Derg 31(1):20–25PubMedPubMedCentral
17.
go back to reference Guadagni S, Cengeli I, Galatioto C et al (2014) Laparoscopic repair of perforated peptic ulcer: single-center results. Surg Endosc 28(8):2302–2308CrossRef Guadagni S, Cengeli I, Galatioto C et al (2014) Laparoscopic repair of perforated peptic ulcer: single-center results. Surg Endosc 28(8):2302–2308CrossRef
18.
go back to reference von Renteln D, Schmidt A, Vassiliou MC et al (2010) Endoscopic full-thickness resection and defect closure in the colon. Gastrointest Endosc 71(7):1267–1273CrossRef von Renteln D, Schmidt A, Vassiliou MC et al (2010) Endoscopic full-thickness resection and defect closure in the colon. Gastrointest Endosc 71(7):1267–1273CrossRef
19.
go back to reference Nishiyama N, Mori H, Kobara H et al (2013) Efficacy and safety of over-the-scope clip: including complications after endoscopic submucosal dissection. World J Gastroenterol 19(18):2752–2760CrossRef Nishiyama N, Mori H, Kobara H et al (2013) Efficacy and safety of over-the-scope clip: including complications after endoscopic submucosal dissection. World J Gastroenterol 19(18):2752–2760CrossRef
Metadata
Title
Over-the-scope-clip applications for perforated peptic ulcer
Authors
Jing-Jing Wei
Xue-Ping Xie
Ting-Ting Lian
Zhi-Yong Yang
Yu-Feng Pan
Zhen-Lv Lin
Guang-Wei Zheng
Ze-Hao Zhuang
Publication date
01-12-2019
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 12/2019
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-019-06717-x

Other articles of this Issue 12/2019

Surgical Endoscopy 12/2019 Go to the issue