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Surgical Endoscopy
Published in: Surgical Endoscopy 6/2020

01-06-2020 | Endoscopy | 2019 SAGES Oral Dynamic

Over-the-scope clip management of non-acute, full-thickness gastrointestinal defects

Authors: David J. Morrell, Joshua S. Winder, Ansh Johri, Salvatore Docimo, Ryan M. Juza, Samantha R. Witte, Vamsi V. Alli, Eric M. Pauli

Published in: Surgical Endoscopy | Issue 6/2020

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Abstract

Background

Endoscopic management of full-thickness gastrointestinal tract defects (FTGID) has become an attractive management strategy, as it avoids the morbidity of surgery. We have previously described the short-term outcomes of over-the-scope clip management of 22 patients with non-acute FTGID. This study updates our prior findings with a larger sample size and longer follow-up period.

Methods

A retrospective analysis of prospectively collected data was conducted. All patients undergoing over-the-scope clip management of FTGID between 2013 and 2019 were identified. Acute perforations immediately managed and FTGID requiring endoscopic suturing were excluded. Patient demographics, endoscopic adjunct therapies, number of endoscopic interventions, and need for operative management were evaluated. Success was strictly defined as complete FTGID closure.

Results

We identified 92 patients with 117 FTGID (65 fistulae and 52 leaks); 27.2% had more than one FTGID managed simultaneously. The OTSC device (Ovesco Endoscopy, Tubingen, Germany) was utilized in all cases. Additional closure attempts were required in 22.2% of defects. With a median follow-up period of 5.5 months, overall defect closure success rate was 66.1% (55.0% fistulae vs. 79.6% leaks, p = 0.007). There were four mortalities from causes unrelated to the FTGID. Only 14.9% of patients with FTGID underwent operative management. There were no complications related to endoscopic intervention and no patients required urgent surgical intervention.

Conclusions

Over-the-scope clip management of FTGID represents a safe alternative to potentially morbid operative intervention. When strictly defining success as complete closure of all FTGID, endoscopy was successful in 64.4% of patients with only a small minority of patients ultimately requiring surgery.
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Metadata
Title
Over-the-scope clip management of non-acute, full-thickness gastrointestinal defects
Authors
David J. Morrell
Joshua S. Winder
Ansh Johri
Salvatore Docimo
Ryan M. Juza
Samantha R. Witte
Vamsi V. Alli
Eric M. Pauli
Publication date
01-06-2020
Publisher
Springer US
Keyword
Endoscopy
Published in
Surgical Endoscopy / Issue 6/2020
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-019-07030-3

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