Over-the-scope clip management of non-acute, full-thickness gastrointestinal defects.
Endoscopy
Fistula
Leak
OTSC
Over-the-scope clip
Journal
Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653
Informations de publication
Date de publication:
06 2020
06 2020
Historique:
received:
15
04
2019
accepted:
19
07
2019
pubmed:
28
7
2019
medline:
29
5
2021
entrez:
28
7
2019
Statut:
ppublish
Résumé
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. 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. 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. 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.
Sections du résumé
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.
Identifiants
pubmed: 31350610
doi: 10.1007/s00464-019-07030-3
pii: 10.1007/s00464-019-07030-3
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2690-2702Références
Verlaan T, Voermans RP, van Berge Henegouwen MI, Bemelman WA, Fockens P (2015) Endoscopic closure of acute perforations of the GI tract: a systematic review of the literature. Gastrointest Endosc 82:618–628.e615
doi: 10.1016/j.gie.2015.03.1977
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 142:954–957
doi: 10.1001/archsurg.142.10.954
Alanezi K, Urschel JD (2004) Mortality secondary to esophageal anastomotic leak. Ann Thorac Cardiovasc Surg 10:71–75
pubmed: 15209546
Luning TH, Keemers-Gels ME, Barendregt WB, Tan AC, Rosman C (2007) Colonoscopic perforations: a review of 30,366 patients. Surg Endosc 21:994–997
doi: 10.1007/s00464-007-9251-7
Jentschura D, Raute M, Winter J, Henkel T, Kraus M, Manegold BC (1994) Complications in endoscopy of the lower gastrointestinal tract therapy and prognosis. Surg Endosc 8:672–676
doi: 10.1007/BF00678564
Garbay JR, Suc B, Rotman N, Fourtanier G, Escat J (1996) Multicentre study of surgical complications of colonoscopy. Br J Surg 83:42–44
doi: 10.1002/bjs.1800830112
Winder JS, Pauli EM (2015) Comprehensive management of full-thickness luminal defects: the next frontier of gastrointestinal endoscopy. World J Gastrointest Endosc 7:758–768
doi: 10.4253/wjge.v7.i8.758
van Boeckel PG, Dua KS, Weusten BL, Schmits RJ, Surapaneni N, Timmer R, Vleggaar FP, Siersema PD (2012) Fully covered self-expandable metal stents (SEMS), partially covered SEMS and self-expandable plastic stents for the treatment of benign esophageal ruptures and anastomotic leaks. BMC Gastroenterol 12:19
doi: 10.1186/1471-230X-12-19
Kim JS, Kim BW, Kim JI, Kim JH, Kim SW, Ji JS, Lee BI, Choi H (2013) Endoscopic clip closure versus surgery for the treatment of iatrogenic colon perforations developed during diagnostic colonoscopy: a review of 115,285 patients. Surg Endosc 27:501–504
doi: 10.1007/s00464-012-2465-3
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 11:60–64
doi: 10.1016/j.soard.2014.06.011
Fernandez-Esparrach G, Lautz DB, Thompson CC (2010) Endoscopic repair of gastrogastric fistula after Roux-en-Y gastric bypass: a less-invasive approach. Surg Obes Relat Dis 6:282–288
doi: 10.1016/j.soard.2010.02.036
Bhardwaj A, Cooney RN, Wehrman A, Rogers AM, Mathew A (2010) Endoscopic repair of small symptomatic gastrogastric fistulas after gastric bypass surgery: a single center experience. Obes Surg 20:1090–1095
doi: 10.1007/s11695-010-0180-5
Raithel M, Albrecht H, Scheppach W, Farnbacher M, Haupt W, Hagel AF, Schellerer V, Vitali F, Neurath MF, Schneider HT (2017) Outcome, comorbidity, hospitalization and 30-day mortality after closure of acute perforations and postoperative anastomotic leaks by the over-the-scope clip (OTSC) in an unselected cohort of patients. Surg Endosc 31:2411–2425
doi: 10.1007/s00464-016-5242-x
Hourneaux de Moura DT, Jirapinyo P, Hathorn KE, Thompson CC (2019) Use of a cardiac septal occluder in the treatment of a chronic GI fistula: what should we know before off-label use in the GI tract? VideoGIE 4:114–117
doi: 10.1016/j.vgie.2018.10.011
Corcelles R, Jamal MH, Daigle CR, Rogula T, Brethauer SA, Schauer PR (2015) Surgical management of gastrogastric fistula. Surg Obes Relat Dis 11:1227–1232
doi: 10.1016/j.soard.2015.03.004
Baron TH, Wong Kee Song LM, Zielinski MD, Emura F, Fotoohi M, Kozarek RA (2012) A comprehensive approach to the management of acute endoscopic perforations (with videos). Gastrointest Endosc 76:838–859
doi: 10.1016/j.gie.2012.04.476
Bemelman WA, Baron TH (2018) Endoscopic management of transmural defects, including leaks, perforations, and fistulae. Gastroenterology 154:1938–1946.e1931
doi: 10.1053/j.gastro.2018.01.067
Lee HL, Cho JY, Cho JH, Park JJ, Kim CG, Kim SH, Han JH (2018) Efficacy of the over-the-scope clip system for treatment of gastrointestinal fistulas, leaks, and perforations: a korean multi-center study. Clin Endosc 51:61–65
doi: 10.5946/ce.2017.027
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 17:1058–1065
doi: 10.1007/s11605-013-2156-y
Niland B, Brock A (2017) Over-the-scope clip for endoscopic closure of gastrogastric fistulae. Surg Obes Relat Dis 13:15–20
doi: 10.1016/j.soard.2016.08.005
Kirschniak A, Traub F, Kueper MA, Stuker D, Konigsrainer A, Kratt T (2007) Endoscopic treatment of gastric perforation caused by acute necrotizing pancreatitis using over-the-scope clips: a case report. Endoscopy 39:1100–1102
doi: 10.1055/s-2007-966848
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 80:610–622
doi: 10.1016/j.gie.2014.03.049
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 27:18–24
doi: 10.1111/den.12295
Winder JS, Kulaylat AN, Schubart JR, Hal HM, Pauli EM (2016) Management of non-acute gastrointestinal defects using the over-the-scope clips (OTSCs): a retrospective single-institution experience. Surg Endosc 30:2251–2258
doi: 10.1007/s00464-015-4500-7
Alli V, Doble J, Pauli E (2017) Multimodal endoscopic therapy for closure of gastro-gastric fistula: The “Triple O” Method., abstr society of American Gastrointestinal and Endoscopic Surgeons 2017 Annual Meeting, Houston, TX
Witte SR, Pauli EM (2018) Endoscopic management of gastrointestinal complications. Dig Dis Interv 2:346–358
doi: 10.1055/s-0038-1675412
Winder JS, Pauli EM (2019) Novel endoscopic modalities for closure of perforations, leaks and fistula in the gastrointestinal tract. Tech Gastrointest Endosc 21:109–114
doi: 10.1016/j.tgie.2019.04.004
Arezzo A, Verra M, Reddavid R, Cravero F, Bonino MA, Morino M (2012) Efficacy of the over-the-scope clip (OTSC) for treatment of colorectal postsurgical leaks and fistulas. Surg Endosc 26:3330–3333
doi: 10.1007/s00464-012-2340-2
Monkemuller K, Peter S, Toshniwal J, Popa D, Zabielski M, Stahl RD, Ramesh J, Wilcox CM (2014) Multipurpose use of the ‘bear claw’ (over-the-scope-clip system) to treat endoluminal gastrointestinal disorders. Dig Endosc 26:350–357
doi: 10.1111/den.12145
Sulz MC, Bertolini R, Frei R, Semadeni GM, Borovicka J, Meyenberger C (2014) Multipurpose use of the over-the-scope-clip system (“Bear claw”) in the gastrointestinal tract: swiss experience in a tertiary center. World J Gastroenterol 20:16287–16292
doi: 10.3748/wjg.v20.i43.16287
Law R, Wong Kee Song LM, Irani S, Baron TH (2015) Immediate technical and delayed clinical outcome of fistula closure using an over-the-scope clip device. Surg Endosc 29:1781–1786
doi: 10.1007/s00464-014-3860-8
Honegger C, Valli PV, Wiegand N, Bauerfeind P, Gubler C (2017) Establishment of over-the-scope-clips (OTSC
doi: 10.1177/2050640616657273
Kobara H, Mori H, Nishiyama N, Fujihara S, Okano K, Suzuki Y, Masaki T (2019) Over-the-scope clip system: a review of 1517 cases over 9 years. J Gastroenterol Hepatol 34:22–30
doi: 10.1111/jgh.14402
Flicker MS, Lautz DB, Thompson CC (2011) Endoscopic management of gastrogastric fistulae does not increase complications at bariatric revision surgery. J Gastrointest Surg 15:1736–1742
doi: 10.1007/s11605-011-1503-0