Top

Published in:

01-11-2012 | Original Article

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

Authors: Alexander Fritzkarl Hagel, Andreas Naegel, Annette Simone Lindner, Hermann Kessler, Klaus Matzel, Wolfgang Dauth, Markus Friedrich Neurath, Martin Raithel

Published in: Journal of Gastrointestinal Surgery | Issue 11/2012

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.

Ribeiro-Mourao F, Pimentel-Nunes P, Dinis-Ribeiro M. Endoscopic submucosal dissection for gastric lesions: results of a European inquiry. Endoscopy 2010;42(10):814–9PubMedCrossRef

Heresbach D, Kornhauser R, Seyring JA, Coumaros D, Claviere C, Bury A, Cottereau J, Canard JM, Chaussade S, Baudet A, Casteur A, Duval O, Ponchon T; OMEGA group. A national survey of endoscopic mucosal resection for superficial gastrointestinal neoplasia. Endoscopy 2010;42(10):806–813PubMedCrossRef

Merchea A, Cullinane DC, Sawyer MD, Iqbal CW, Baron TH, Wigle D, Sarr MG, Zielinski MD. Esophagogastroduodenoscopy-associated gastrointestinal perforations: a single-center experience. Surgery. 2010;148(4):876–80PubMedCrossRef

Morris AM, Baldwin LM, Matthews B, Dominitz JA, Barlow WE, Dobie SA, Billingsley KG. Reoperation as a quality indicator in colorectal surgery. A population-based analysis. Ann Surg 2007;245:73–79PubMedCrossRef

Minami S, Gotoda T, Ono H, Oda I, Hamanaka H. Complete endoscopic closure of gastric perforation induced by endoscopic resection of early gastric cancer using endoclips can prevent surgery (with video). Gastrointest Endosc 2006;63:596–601PubMedCrossRef

Luján JJ, Németh ZH, Barratt-Stopper PA, Bustami R, Koshenkov VP, Rolandelli RH. Factors influencing the outcome of intestinal anastomosis. AmSurg. 2011;77(9):1169–75.PubMed

Rutegård M, Lagergren P, Rouvelas I, Lagergren J. Intrathoracic anastomotic leakage and mortality after esophageal cancer resection: a population-based study. Ann Surg Oncol. 2012;19:99–103.

Parodi A, Repici A, Pedroni A, Blanchi S, Conio M. Endoscopic managment of GI perforations with a new over-the-scope clip device (with video). Gastrointest Endosc 2010;72(4):881–886PubMedCrossRef

Traina M, Curcio G, Tarantino I, Soresi S, Barresi L, Vitulo P, Gridelli B. New endoscopic over-the-scope clip system for closure of a chronic tracheoesophageal fistula. Endoscopy. 2010;42(Suppl 2):E54–5PubMedCrossRef

10.

von Renteln D, Rudolph HU, Schmidt A, Vassiliou MC, Caca K. Endoscopic closure of duodenal perforations by using an over-the-scope clip: a randomized, controlled porcine study. Gastrointest Endosc 2010;71(1):131–138CrossRef

11.

Seebach L, Bauerfeind P, Gubler C. “Sparing the surgeon”: clinical experience with over-the-scope clips for gastrointestinal perforation. Endoscopy 2010;42(12):1108–1111PubMedCrossRef

12.

Pohl J, Borgulya M, Lorenz D, Ell C. Endoscopic closure of postoperative esophageal leaks with a novel over-the-scope system. Endoscopy 2010;42(9):757–759PubMedCrossRef

13.

Voermans RP, Le Moine O, von Renteln D, Ponchon T, Giovannini M, Bruno M, Weusten B, Seewald S, Costamagna G, Deprez P, Fockens P; CLIPPER Study Group. Efficacy of endoscopic closure of acute perforations of the gastrointestinal tract. Clin Gastroenterol Hepatol. 2012 Jun;10(6):603–8. Epub 2012 Feb 20.PubMedCrossRef

14.

Iqbal CW, Cullinane DC, Schiller HJ, Sawyer MD, Zietlow SP, Farley DR. Surgical management and outcomes of 165 colonoscopic perforations from a single institution. Arch Surg. 2008 Jul;143(7):701–6; discussion 706–7.PubMedCrossRef

15.

Voermans RP, van Berge Henegouwen MI, Bemelman WA, Fockens P. Novel over-the-scope-clip system for gastrotomy closure in natural orifice transluminal surgery (NOTES): an ex vivo comparison study. Endoscopy.2009 Dec;41(12):1052–5.PubMedCrossRef

16.

Taku K, Sano Y, Fu KI, Saito Y, Matsuda T, Uraoka T, Yoshino T, Yamaguchi Y, Fujita M, Hattori S, Ishikawa T, Saito D, Fujii T, Kaneko E, Yoshida S. Iatrogenic perforations associated with therapeutic colonoscopy : a multicenter study in Japan. J Gastroenterol Hepatol 2007; 22: 1409–1414PubMedCrossRef

17.

Neumann H, Naegel A, Bernatik T, Wickles N, Neurath MF, Raithel M. Endoscopic closure of large spontaneous choledochoduodenal fistula using the over-the-scope clip (OTSC). Gastrointest Endosc. 2011 Jul;74(1):200–2;PubMedCrossRef

18.

Kirschniak A, Traub F, Kueper MA, Stüker D, Königsrainer A, Kratt T. Endoscopic treatment of gastric perforation caused by acute necrotizing pancreatitis using over-the-scope clips: a case. Endoscopy 2007; 39(12): 1100–1102PubMedCrossRef

19.

Saito Y, Uraoka T, Yamaguchi Y, Hotta K, Sakamoto N, Ikematsu H, Fukuzawa M, Kobayashi N, Nasu J, Michida T, Yoshida S, Ikehara H, Otake Y, Nakajima T, Matsuda T, Saito D. A prospective multicenter study of 1111 colorectal endoscopic submucosal dissections (with video). Gastrointest Endosc 2010; 72: 1217–1225PubMedCrossRef

Title: Over-the-Scope Clip Application Yields a High Rate of Closure in Gastrointestinal Perforations and May Reduce Emergency Surgery
Authors: Alexander Fritzkarl Hagel
Andreas Naegel
Annette Simone Lindner
Hermann Kessler
Klaus Matzel
Wolfgang Dauth
Markus Friedrich Neurath
Martin Raithel
Publication date: 01-11-2012
Publisher: Springer-Verlag
Published in: Journal of Gastrointestinal Surgery / Issue 11/2012
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-012-1983-6

At a glance: The STEP trials

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 11/2012

Surgical Endoscopic Vacuum Therapy for Anastomotic Leakage and Perforation of the Upper Gastrointestinal Tract

Duodenum-Preserving Total Pancreatic Head Resection for Benign Cystic Neoplastic Lesions

Randomized Controlled Trial of Emergency Transjugular Intrahepatic Portosystemic Shunt Versus Emergency Portacaval Shunt Treatment of Acute Bleeding Esophageal Varices in Cirrhosis

Is There a Role for Simultaneous Hepatic and Colorectal Resections? A Contemporary View from NSQIP

Significance of the Inflammation-Based Glasgow Prognostic Score for Short- and Long-Term Outcomes After Curative Resection of Gastric Cancer

In Vivo Analysis of the Morphologic Characteristics of Synthetic Mesh to Resist MRSA Adherence