Focused Review Series: Endoscopic Management of Postoperative Gastrointestinal Complication: What’s New?
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Over-the-Scope Clip in the Treatment of Gastrointestinal Leaks and Perforations
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Mike T. Wei, Ji Yong Ahn, Shai Friedland
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Clin Endosc 2021;54(6):798-804. Published online November 30, 2021
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DOI: https://doi.org/10.5946/ce.2021.250
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Abstract
PDFPubReaderePub
- While perforations, postoperative fistulas, and leaks have traditionally led to surgical or interventional radiology consultation for management, the introduction of the over-the-scope clip has allowed increased therapeutic possibilities for endoscopists. While primarily limited to case reports and series, the over-the-scope clip successfully manages gastrointestinal bleeding, perforations, as well as postoperative leaks and fistulas. Retrospective studies have demonstrated a relatively high success rate and a low complication rate. Given the similarity to variceal banding equipment, the learning curve with the over-the-scope clip is rapid. However, given the higher risk of procedures involving the use of the over-the-scope clip, it is essential to obtain the scope in a stable position and grasp sufficient tissue with the cap using a grasping tool and/or suction. From our experience, while closure may be successful in lesions sized up to 3 cm, successful outcomes are obtained for lesions sized <1 cm. Ultimately, given the limited available data, prospective randomized trials are needed to better evaluate the utility of the over-the-scope clip in various clinical scenarios, including fistula and perforation management.
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Citations
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Original Article
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Efficacy of the Over-the-Scope Clip System for Treatment of Gastrointestinal Fistulas, Leaks, and Perforations: A Korean Multi-Center Study
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Hang Lak Lee, Joo Young Cho, Jun-Hyung Cho, Jong Jae Park, Chan Gyoo Kim, Seong Hwan Kim, Joung-Ho Han
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Clin Endosc 2018;51(1):61-65. Published online August 29, 2017
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DOI: https://doi.org/10.5946/ce.2017.027
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Abstract
PDFPubReaderePub
- Background
/Aims: Currently, a new over-the-scope clip (OTSC) system has been introduced. This system has been used for gastrointestinal perforations and fistulas in other countries. The aim of our study is to examine the therapeutic success rate of endoscopic 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 perforations due to Boerhaave’s syndrome. Among these, there were three gastrojejunostomy sites, three esophagojejunostomy sites, four esophagogastrostomy 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 the leakage ranged from 5 to 30 mm. The median procedure time was 16 min. All cases were technically successful. Complete closure of the 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 of anastomotic leakage after surgery.
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