A new endoscopic over-the-scope clip system for treatment of lesions and bleeding in the GI tract: first clinical experiences

Kirschniak, Andreas; Kratt, Thomas; Stüker, D; Braun, Alexander; Schurr, Marc-Oliver; Königsrainer, Alfred

doi:10.1016/j.gie.2007.01.034

Cited by 314 publications

(214 citation statements)

References 13 publications

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“…Direct endoluminal closures of iatrogenic perforations have been reported with clips (through-the-scope, over-the-scope) and endoluminal suturing techniques (41)(42)(43). A recent metaanalysis reviewed current literature reporting on endoclip technique in closure of iatrogenic perforations.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic management of esophageal leaks

Ong¹,

Freeman²

2017

J. Thorac. Dis.

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Traditionally, gold standard treatment for an acute esophageal perforation has been operative repair. Over the past two decades, there has been a paradigm shift towards the use of esophageal stents.Recent advances in biomaterial allowed a new generation of stents to be manufactured that combined (I) a non-permeable covering; (II) radial force sufficient to occlude a transmural esophageal injury and (III) improved ease of removability. The amalgamation of these developments set the stage for utilizing esophageal stents as part of the management algorithm of an acute esophageal perforation. This provides a safe and less invasive treatment route in lieu of direct primary repair and its well-documented significant failure rate. Esophageal stent placement for failed operative repair or esophageal leaks also had the potential to minimize the need for esophageal resection and diversion. When included in a multimodality hybrid treatment protocol, esophageal stents can optimize healing success rates and minimize the risks of adverse J Thorac Dis 2017;9(Suppl 2):S135-S145 jtd.amegroups.com significantly less esophageal dilatation, a lower rate of migration and improved palliation for malignant esophageal strictures and malignant tracheo-esophageal fistulae (10,11). However, placement of these prostheses continued to be reserved only for the patient requiring palliative therapy for a malignancy because of the potential esophageal damage associated with extraction including reports of irreparable, sometimes life threatening, fistulae.To combat these complications, second generation metallic stent designs were developed incorporating a covering of silicone, polyurethane or other polymers (12). While offering the advantage of diminishing amount of tumor ingrowth and fixation to the esophageal wall, it came with the cost of higher migration rates. Later, the ends of these covered stents were modified to be partially covered with a margin of 1.5 cm on both proximal and distal ends to optimize purchase of the esophageal wall (13).Further evolution in esophageal stent biomaterials resulted in the development of an occlusive plastic prosthesis coated with silicone. This new design allowed ease of insertion, a minimal requirement for esophageal dilation and the ability to form an occlusive seal within the lumen of the esophagus (14). The distinctive advantage of these non-metallic endoprostheses was the ability for removal or replacement even after an extended period of time without damage to the esophagus. However, similar to the covered metallic stents, a higher incidence of migration was appreciated (15).These synergistic developments led to a crucial turning point in management of esophageal perforations. The ease in manipulation of high-quality covered, occlusive stents in the esophagus, led some investigators to implant these stents in select patients as a temporary measure to treat intrathoracic anastomotic leaks following esophagogastrostomy and acute perforations. Segalin et al. and Roy-Choudhury et al. were am...

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Section: Discussionmentioning

confidence: 99%

Endoscopic management of esophageal leaks

Ong¹,

Freeman²

2017

J. Thorac. Dis.

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“…A twin grasper with two branches which can be opening separately and an anchor are available (1). Two different configurations are available: The atraumatic version with blunt teeth, and the traumatic version with sharp teeth (7,8), the choice between them depends on the kind of lesion to treat. One drawback of OTSC is that it is placed onto the tip of the scope, which makes the removal of the endoscope from the patient necessary (7) and it may be difficult to reach the lesion again.…”

Section: Discussionmentioning

confidence: 99%

Ovesco system for treatment of postpolypectomy bleeding after failure of conventional treatment

Alcaide

Peñas-Herrero

Sancho-del-Val

et al. 2014

Rev. esp. enferm. dig.

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The clip Ovesco (Ovesco, Tübingen, Germany) is a novel endoscopic method for mechanical compression of tissue in the gastrointestinal tract. The indications for treatment are closure of perforations and fistulas and control of bleeding in which the conventional endoscopic treatment has failed. We report two cases about the use of an Ovesco (over-the-scope clip, OTSC) system to control persistent bleeding postpolypectomy after failure of usual treatment.Key words: Ovesco. Nitinol clip. Hemostasis. Gastrointestinal bleeding. CASE REPORTS Case report 1A 65-year-old woman with no medical history of interest underwent gastroscopy due to iron-deficiency anemia. A 4-cm pedunculated polyp with wide stalk in the antrum was noted. Polypectomy was performed with a snare after injection with epinephrine. Immediately, it showed arterial bleeding that was treated unsuccessfully with sclerotherapy with epinephrine and etoxiesclerol and application of endoclips (Olympus, Hamburg, Germany) ( Fig. 1 A-C). Therefore, placement of an Ovesco with rounded edges by its insertion in the distal end of a therapeutic gastroscope (Olympus GIF 1TQ160) was decided. Bleeding was very profuse and prevented from locating the bleeding vessel. The anchor was used to bind tissue margins and to pull them into the cap before clip release. Hemostasis was achieved promptly (Fig. 2). Case report 2An ambulatory colonoscopy was performed on a 71-yearold woman for colorectal cancer screening. The patient was carrier of a prosthetic metal heart valve in mitral position. Prior to colonoscopy, oral anticoagulant was retired according to hospital protocol. Two sessile polyps of 15-mm and 20-mm were removed in sigma by a snare polypectomy and previous submucosa injection of epinephrine. Three days after, the patient was admitted into hospital with rectal bleeding. Laboratory test revealed hemoglobin of 9.7 g/dL. A new colonoscopy was performed, an adherent clot in the proximal polypectomy was observed (Fig. 3). It was removed and two hemoclips were placed. Base of resection from the distal polypectomy was covered with fibrin without bleeding. However, three days later, the patient began with new episode of rectal bleeding. It was noted a clot in the base of resection from the proximal polypectomy and hemoclips were gone. It was placed endoclips and endoloop closure technique (Fig. 4). A clip was applied in the distal polypectomy for added security although it did not show any signs of bleeding. Sodium heparin intravenous infusion was started since it was not possible to reintroduce anticoagulant oral and the risk of recurrent rectal bleeding. The patient was attended again, 48 hours later, because of another episode of rectal bleeding from ulcer caused by clips of the base of resection from proximal polypectomy (Fig. 5A). An OTSC was used at that time because of the failure to control bleeding using conventional endoscopic treatments. Same endoscope and kind of OTSC as in previ- Rev Esp Enferm Dig 2014;106:55-58.

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“…A new over-the-scope clip system called OTSC (Ovesco Endoscopy, Tuebingen, Germany) has been developed (9). It is a nitinol clip loaded at the tip of the endoscope that can capture a large amount of tissue and compress the lesions until healing.…”

Section: Introductionmentioning

confidence: 99%

“…Experimental studies have demonstrated the ability of the OTSC to close perforations (10)(11)(12) and the superiority of OTSCs relative to TTS clips for closure of perforations (13,14). However, data regarding its role in the management of perforations in humans are scant (9,(15)(16)(17)(18)(19)(20)(21)(22).…”

Section: Introductionmentioning

confidence: 99%