Endoscopic treatment of gastrointestinal fistulas using an over-the-scope clip (OTSC) device: Case series from a tertiary referral center

Abstract

Gastrointestinal perforations and post-surgical fistulas are dreaded complications that dramatically increase morbidity and mortality. A new endoscopic over-the-scope clip (OTSC) system may be potentially useful for sealing visceral perforations in several clinical settings. We evaluated the advantages and clinical impact of the placement of OTSCs on the management of non-malignant gut leaks in 12 consecutive patients. OTSCs of 9.5 or 10.5 mm were used, according to the diameter of the defect within the wall. The indications for treatment were mainly related to post-surgical fistulas. Healing of the fistula was assessed by endoscopic or radiological means, and failed only once. No OTSC-related complications occurred. Endoscopic closure of perforations and post-surgical fistulas with the OTSC system is a simple and minimally invasive technique. This approach, when feasible, may be less expensive and more advantageous than a surgical approach.

Endoscopic Deployment of MatriStem for Treatment of a Colorectal Anastomotic Leak

“…Successful treatment of 2 patients with 7-mm colorectal anastomotic leaks was reported using an Over-theScope Clip device (Ovesco, Tübingen, Germany). 2 For more complicated anastomotic leaks (Ͻ1.5 cm) associated with an abscess cavity, Verlaan et al 3 introduced a novel method using a sponge-like device connected to suction to reduce the size of the anastomotic defect and associated abscess cavity. After treatment with the device, called an "endosponge," the residual defect was closed with sutures via a transanal approach or an Over-the-Scope Clip device.…”

“…To avoid the hazards of reoperation, minimally invasive endoscopic techniques have been recently proposed as an alternative for salvaging colorectal anastomotic leaks. [2][3][4] One such extracellular matrix scaffold is urinary bladder matrix (UBM), which is composed of the epithelial basement membrane and tunica propria of the porcine urinary bladder and is decellularized, disinfected, dried, and sterilized. It is commercially available under the trade name MatriStem (ACell, Columbia, Maryland).…”

Management of gastrointestinal tract perforations

“…Four relevant studies have highlighted the efficacy of OTSCs with a total success rate of greater than 95% (22 patients). [24][25][26][27] The closure process for an OTSC is as follows. 28 (1) The center of one of the lateral edges of the perforation is grasped using one arm of the OTSC Twin Grasper.…”

“…30,31 Stents may be a better option for perforations or fistulas > 2 cm and for defects with everted edges in the esophagus. 27 A perforation in the GI tract with a stricture is a good indication for the endoscopic closure method.…”

Endoscopic management of postoperative fistulas and leaks

“…13,15,16 Postoperative leaks after esophagectomy occur in up to 35% of cases 17 and 4% to 27% after gastrectomy, carrying a mortality as high as 65%. 18,19 Intrathoracic leak following esophagectomy carries higher mortality compared to cervical leak 20 and if there is a delay in treatment for over 24 hours, mortality approaches as high as 50%.…”