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Over-the-Scope Clip in the Treatment of Gastrointestinal Leaks and Perforations
Mike T. Wei,Ji Yong Ahn,Shai Friedland 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.6
While perforations, postoperative fistulas, and leaks have traditionally led to surgical or interventional radiology consultation formanagement, the introduction of the over-the-scope clip has allowed increased therapeutic possibilities for endoscopists. Whileprimarily limited to case reports and series, the over-the-scope clip successfully manages gastrointestinal bleeding, perforations, aswell as postoperative leaks and fistulas. Retrospective studies have demonstrated a relatively high success rate and a low complicationrate. Given the similarity to variceal banding equipment, the learning curve with the over-the-scope clip is rapid. However, given thehigher risk of procedures involving the use of the over-the-scope clip, it is essential to obtain the scope in a stable position and graspsufficient tissue with the cap using a grasping tool and/or suction. From our experience, while closure may be successful in lesionssized up to 3 cm, successful outcomes are obtained for lesions sized <1 cm. Ultimately, given the limited available data, prospectiverandomized trials are needed to better evaluate the utility of the over-the-scope clip in various clinical scenarios, including fistula andperforation management.
Endoscopic Management with a Novel Over-The-Scope Padlock Clip System
Mahesh Kumar Goenka,Gajanan Ashokrao Rodge,Indrajeet Kumar Tiwary 대한소화기내시경학회 2019 Clinical Endoscopy Vol.52 No.6
Background/Aims: The Padlock clip is a recently introduced over-the-scope clip (OTSC) that requires the use of an alternate techniqueand has a different design from previous OTSCs. However, data regarding its clinical use are limited. The aim of this study is to presentour clinical experience using this novel Padlock clip system. Methods: Between September 2018 and June 2019, 7 consecutive patients underwent Padlock clip application at our center by anexperienced endoscopist. A Padlock clip was used for achieving hemostasis in 4 patients presenting with gastrointestinal (GI) bleeding,as well as for endoscopic full-thickness resection in the remaining 3 patients. Results: All 7 patients achieved technical as well as clinical success, with absence of complications or rebleeding, during a follow-up ofa minimum of 3 weeks. All patients were hospitalized post procedure for a minimum of 48 hours, and an absence of adverse events wasnoted in our patient population throughout the procedure and post-procedure period. Antiplatelet therapy was reinstated shortly afterthe application of the Padlock clip, with no GI bleeding observed. Conclusions: The Padlock clip is a novel OTSC, with benefits that include safe, simple, and rapid deployment. Antiplatelet therapy maybe reinstated for patients, when necessary, shortly after applying the Padlock clip due to full-thickness closure of the tissue.
Yoshihisa Arao,Yuichi Sato,Satoru Hashimoto,Hiroki Honda,Kazumi Yoko,Masaaki Takamura,Ken-ichi Mizuno,Masaaki Kobayashi 대한소화기내시경학회 2015 Clinical Endoscopy Vol.48 No.6
A 50-year-old woman had a percutaneous endoscopic gastrostomy (PEG) tube placed after surgery for pharyngeal cancer. After 21 months, the PEG tube was removed due to improvement of per-oral ingestion. She had taken prednisolone for 31 years for systemic lupus erythematosus. The post-PEG fistula did not close spontaneously. The cause of the fistula was slow wound healing and gastrostomy site inflammation due to long-term steroid therapy. We were able to close the fistula with an over-the-scope clipping (OTSC) system. This case suggests that OTSC is useful for closing persistent post-PEG fistulas in patients receiving long-term prednisolone therapy.
Hang Lak Lee,Joo Young Cho,조준형,Jong-Jae Park,Chan Gyoo Kim,Seong Hwan Kim,Joung-Ho Han 대한소화기내시경학회 2018 Clinical Endoscopy Vol.51 No.1
Background/Aims: Currently, a new over-the-scope clip (OTSC) system has been introduced. This system has been used forgastrointestinal perforations and fistulas in other countries. The aim of our study is to examine the therapeutic success rate ofendoscopic treatment using the OTSC system in Korea. Methods: This was a multicenter prospective study. A total of seven endoscopists at seven centers performed this procedure. Results: A total of 19 patients were included, with gastrointestinal leakages from anastomosis sites, fistulas, or esophageal perforationsdue to Boerhaave’s syndrome. Among these, there were three gastrojejunostomy sites, three esophagojejunostomy sites, fouresophagogastrostomy sites, one esophagocolonostomy site, one jejuno-jejunal site, two endoscopic full thickness resection site closures,one Boerhaave’s syndrome, two esophago-bronchial fistulas, one gastrocolonic fistula, and one colonopseudocyst fistula. The size of theleakage ranged from 5 to 30 mm. The median procedure time was 16 min. All cases were technically successful. Complete closure ofthe leak was achieved in 14 of 19 patients using OTSC alone. Conclusions: The OTSC system is a safe and effective method for the management of gastrointestinal leakage, especially in cases ofanastomotic leakage after surgery.
Woong Cheul Lee,Weon Jin Ko,Jun-Hyung Cho,Tae Hee Lee,Seong Ran Jeon,Hyun Gun Kim,Joo Young Cho 대한소화기내시경학회 2014 Clinical Endoscopy Vol.47 No.2
Recently, increasingly invasive therapeutic endoscopic procedures and more complex gastrointestinal surgeries such as endoscopic mucosalresection, endoscopic submucosal dissection, and novel laparoscopic approaches have resulted in endoscopists being confrontedmore frequently with perforations, fistulas, and anastomotic leakages, for which nonsurgical closure is desired. In this article, we presentour experiences with the use of over-the-scope clip (OTSC) for natural orifice transluminal endoscopic surgery (NOTES) closure, preventionof perforation, anastomotic leakages, and fistula closures. The OTSC is a valuable device for closing intestinal perforations and fistulas,for NOTES closure, and for the prevention of perforation after the excision of a tumor from the proper muscle layer. Furthermore, itseems to be quite safe to perform, even by endoscopists with little experience of the technique.
Endoscopic clipping in non-variceal upper gastrointestinal bleeding treatment
Giuseppe Galloro,Angelo Zullo,Gaetano Luglio,Alessia Chini,Donato Alessandro Telesca,Rosa Maione,Matteo Pollastro,Giovanni Domenico De Palma,Raffaele Manta 대한소화기내시경학회 2022 Clinical Endoscopy Vol.55 No.3
Since the earliest reports, advanced clipping systems have been developed, and it is possible to choose among many models with differentstructural and technical features. The main drawback of through-the-scope clips is their small size, which allows the compressionof limited amounts of tissue needed for large-size vessel treatment. Therefore, the over-the-scope clip system was realized, allowing alarger and stronger mechanical compression of large tissue areas, with excellent results in achieving a definitive hemostasis in difficultcases. Many studies have analyzed the indications and efficacy of two-pronged endoclips and have shown good results for initial andpermanent hemostasis. The aim of this review was to provide updated information on indications, positioning techniques, and resultsof clip application for endoscopic treatment of upper gastrointestinal non-variceal bleeding lesions.
Mahesh Kumar Goenka,Vijay Kumar Rai,Usha Goenka,Indrajit Kumar Tiwary 대한소화기내시경학회 2017 Clinical Endoscopy Vol.50 No.1
Background/Aims: The over-the-scope clip (OTSC) is a device used for endoscopic closure of perforations, leaks and fistulas, and for endoscopic hemostasis. To evaluate the clinical effectiveness and safety of OTSC. Methods: Between October 2013 and November 2015, 12 patients underwent OTSC placement by an experienced endoscopist. OTSC was used for the closure of gastrointestinal (GI) leaks and fistula in six patients, three of which were iatrogenic (esophageal, gastric, and duodenal) and three of which were inflammatory. In six patients, OTSC was used for hemostasis of non-variceal upper GI bleeding. Endoscopic tattooing using India ink was used to assist the accurate placement of the clip. Results: All subjects except one with a colonic defect experienced immediate technical success as well as long-term clinical success, during a mean follow-up of 6 weeks. Only one clip was required to close each of the GI defects and to achieve hemostasis in all patients. There were no misfirings or complications of clips. The procedure was well tolerated, and patients were hospitalized for an average of 8 days (range, 3 to 10). Antiplatelet therapy was continued in patients with GI bleeding. Conclusions: In our experience, OTSC was safe and effective for the closure of GI defect and to achieve hemostasis of non-variceal GI bleeding.
Treatment of Traumatic Esophagopleural Fistula Using the Over-the-Scope-Clip System
김지형,박종재,정일우,김상훈,김희동,최정완,주문경,김현구 대한소화기내시경학회 2015 Clinical Endoscopy Vol.48 No.5
Esophagopleural fistula (EPF) is a rare condition that is usually accompanied by severe infection and life-threatening morbidity. Here, we report the successful treatment of an EPF by closing an esophageal orifice using the over-the-scope-clip (OTSC) system without postprocedural complications. A 41-year-old man had serious thoracic and abdominal trauma due to a traffic accident. Computed tomography revealed findings suggestive of esophageal rupture due to Boerhaave syndrome. An emergent explorative operation was performed for primary repair with the insertion of a vacuum-assisted closure device. A postoperative upper gastrointestinal series revealed an EPF tract connecting the left pleural space and distal esophagus. We performed an endoscopic procedure using the “traumatic-type” OTSC to seal the EPF, and the esophageal orifice was completely healed 2 weeks postoperatively. The OTSC system might represent a safe and feasible modality for the treatment of EPF.
Sun Young Moon,정민규,Jun Heo 대한소화기내시경학회 2022 Clinical Endoscopy Vol.55 No.3
Percutaneous endoscopic gastrostomy (PEG) is a common method for providing long-term enteral nutrition to patients. PEG tubeplacement and removal are relatively safe; generally, a PEG tube can be removed using gentle traction, and excessive bleeding is rare. The over-the-scope clip system is a new device that can be used for gastrointestinal hemostasis and for closing gastrointestinal fistulae. In the present case, a 68-year-old male patient had to remove the PEG tube because of persistent leakage around the PEG tube. Althoughit was gently removed using traction, incessant bleeding continued, with a Rockall score of 5 points, even after hemocoagulationwas attempted. An over-the-scope clip device was used to achieve hemostasis and fistula closure.
Nonthalee Pausawasdi,Chotirot Angkurawaranon,Tanyaporn Chantarojanasiri,Arunchai Chang,Wanchai Wongkornrat,Somchai Leelakusolvong,Asada Methasate 대한소화기내시경학회 2020 Clinical Endoscopy Vol.53 No.3
Tracheoesophageal fistulas (TEFs) have traditionally been managed surgically, but the endoscopic approach is widely performed asa less invasive alternative. Different closure techniques have been proposed with inconsistent results. An over-the-scope clip (OTSC)appears to be a reasonable option, but long-term results have not been well defined. We report the long-term outcomes of a complexcase of successful closure of a benign refractory TEF using an OTSC after failed surgical management and esophageal stent placement.