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

Hagel, Alexander; Naegel, Andreas; Lindner, Annette; Keßler, Hermann; Matzel, Klaus E.; Dauth, Wolfgang; Neurath, Markus F.; Raithel, Martin

doi:10.1007/s11605-012-1983-6

Cited by 88 publications

(40 citation statements)

References 19 publications

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“…The superiority of OTSCs relative to TTS clips for closure of gastrointestinal perforations and natural orifice transluminal endoscopic surgery (NOTES) access points was reported in extensive animal trials 14 15 16 17. Recently, case reports and small case series in humans have confirmed these promising results 18 19. Since data from clinical use are still limited, we present our experience with OTSC in management of gastrointestinal perforations occurring during an endoscopic procedure.…”

Section: Introductionmentioning

confidence: 86%

Over-the-scope clip (OTSC) reduces surgery rate in the management of iatrogenic gastrointestinal perforations

et al. 2017

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Background and study aims Over-the-scope clip (OTSC) has been recently used in management of gastrointestinal perforations, but data on it are still limited. The aim of this study was to compare management of iatrogenic perforations before and after the OTSC was available in our endoscopy unit. Patients and methods We conducted a monocentric retrospective study from June 2007 to June 2015. All iatrogenic gastrointestinal perforations detected during endoscopy were included. Two time periods were compared in terms of surgery and mortality rates: before use of OTSC (June 2007 to June 2011) and after OTSC became available (June 2011 to June 2015). Results During the first period, 24 perforations were recorded. Fifteen (62.5 %) were managed with surgery. The mortality rate was 8 %. During the second period, 16 perforations occurred. In 11 patients (68.7 %), an OTSC was used to close the perforation, with complete sealing of the perforation in 100 % of cases. However, 2 patients with sigmoid perforation had to undergo surgery due to right ureteral obstruction by the clip in 1 case and to presence of a localized peritonitis in the other. The surgery rate during this period was 12.5 % (2 /16), with a statistically significant difference compared to the first period (P = 0.002). There was no mortality in the second period versus 8 % in the first one (P = 0.23). Conclusions OTSC is effective for endoluminal closure of iatrogenic perforations and results in a significant decrease in surgery rate.

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Section: Introductionmentioning

confidence: 86%

Over-the-scope clip (OTSC) reduces surgery rate in the management of iatrogenic gastrointestinal perforations

et al. 2017

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“…Damit können auch größere Defekte mit einer Effizienz bis zu 100% verschlossen werden. Aber auch hier liegen nur vereinzelte, kleine Fallserien von sehr selektionierten Patientengruppen vor [8,11].…”

Section: Endoskopisches Managementunclassified

Kardianahe Perforation bei gutartigen Erkrankungen

Schröder

Leers

Bludau

et al. 2014

Chirurg

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Esophageal perforations nearby the cardia are a clinical disorder of various causes. Perforations occur most often following diagnostic or interventional endoscopy but spontaneous perforations (Boerhaave syndrome) are less frequent. Due to the heterogeneous etiology there is a broad range of therapeutic options. In most cases the esophageal perforation site can be covered by an endoscopic stent. Recent endoscopic procedures are the intraluminal application of an endoscopic vacuum-assisted closure system (endo-VAC) or clipping of the esophageal defect. Surgical procedures include direct suturing with external coverage of the defect or transhiatal blunt dissection of the esophagus without primary reconstruction. All endoscopic and surgical procedures often require an additional drainage of the mediastinum and if necessary of the thoracic and abdominal cavities. The clinical presentation ranges from a simple perforation without concomitant esophageal pathology to a defect of considerable length with pleural perforation and associated septic multiple organ failure. The severity of the septic course is the crucial parameter for the choice of the procedure. An early multiple organ failure indicates an insufficient drainage of the septic focus and is indicative for surgical resection. The overall mortality is given as 12 % in the current literature and primarily depends on the localization and the etiology of the perforation. The highest mortality rates are observed with Boerhaave syndrome. The most important prognostic variable is the time interval between perforation and initiation of therapy whereby the mortality rises up to 20 % if the interval exceeds 24 h. Due to the complex therapy and the poor prognosis esophageal perforations should be treated in specialized centers.

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“…Vacuum-assisted therapy is also a possible technique [105]. OTSC brings technical difficulties in oesophageal application because of narrow lumen and oblique orientation [106].…”

Section: Location Particularitiesmentioning

confidence: 99%

“…Shi et al described a new combination technique of metallic clips and endoloops as interrupted suture after endoscopic full-thickness resection of gastric submucosal tumours in 20 patients [97]; when the defect is large (25 mm) it can as well be managed by the omental-patch method or the OTSC system [93,106].…”

Section: Location Particularitiesmentioning

confidence: 99%

Emergencies after endoscopic procedures

Rolanda

Caetano

Dinis-Ribeiro

2013

Best Practice & Research Clinical Gastroenterology

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Keywords:GI endoscopy adverse events GI emergencies Bleeding Haemorrhage Perforation Infection Embolization Diagnosis and management of severe complications a b s t r a c t Endoscopy adverse events (AEs), or complications, are a rising concern on the quality of endoscopic care, given the technical advances and the crescent complexity of therapeutic procedures, over the entire gastrointestinal and bilio-pancreatic tract. In a small percentage, not established, there can be real emergency conditions, as perforation, severe bleeding, embolization or infection. Distinct variables interfere in its occurrence, although, the awareness of the operator for their potential, early recognition, and local organized facilities for immediate handling, makes all the difference in the subsequent outcome. This review outlines general AEs' frequencies, important predisposing factors and putative prophylactic measures for specific procedures (from conventional endoscopy to endoscopic cholangio-pancreatography and ultrasonography), with comprehensive approaches to the management of emergent bleeding and perforation.

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

Cited by 88 publications

References 19 publications

Over-the-scope clip (OTSC) reduces surgery rate in the management of iatrogenic gastrointestinal perforations

Over-the-scope clip (OTSC) reduces surgery rate in the management of iatrogenic gastrointestinal perforations

Kardianahe Perforation bei gutartigen Erkrankungen

Emergencies after endoscopic procedures

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