Abstract
Background
The Over-The-Scope Clip (OTSC®) enables the treatment of patients with gastrointestinal complications such as bleeding, perforations, and fistulas. The aim of this retrospective study was to analyze the therapeutic results of the performed treatments.
Methods
Since April 2006, 50 patients have been treated for different indications with the OTSC clip in our department. Besides hemostasis (n = 27) in the colon and the upper GI tract, the clip has been used for closure of esophageal and gastric perforations and adaptation of covered and free perforations after colonoscopy (n = 11). Furthermore, the OTSC has been used to close fistulas (n = 8) and for preoperative marking (n = 4).
Results
The primary treatment was successful in all cases. There were two secondary bleedings that required endoscopic interventions. Closure of iatrogenic perforations of the upper and lower GI tract was successful in all cases. A permanent closure of fistulas could not be achieved in all cases with the OTSC clip.
Conclusion
The OTSC clip is effective and safe for complicated bleeding and closure of perforations of the gastrointestinal tract. Nevertheless, sufficient closure of chronic fistulas with the OTSC still remains an unsolved problem.
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References
Kirschniak A (2002) Entwicklung und Erprobung eines superelastischen Clipsystems zur Behandlung des blutenden peptischen Ulcus. Promotionsschrift. Department of Surgery, Eberhard-Karls University, Tuebingen
Schurr MO, Hartmann C, Ho CN, Fleisch C, Kirschniak A (2008) An over-the-scope clip (OTSC) system for closure of iatrogenic colon perforations: results of an experimental survival study in pigs. Endoscopy 40:584–588
Schurr MO, Hartmann C, Kirschniak A, Ho CN, Fleisch C, Buess G (2008) Experimental study on a new method for colonoscopic closure of large-bowel perforations with the OTSC clip. Biomed Tech (Berl) 53:45–51
Kirschniak A, Kratt T, Stuker D, Braun A, Schurr MO, Konigsrainer A (2007) A new endoscopic over-the-scope clip system for treatment of lesions and bleeding in the GI tract: first clinical experiences. Gastrointest Endosc 66:162–167
Arezzo A, Kratt T, Schurr MO, Morino M (2009) Laparoscopic-assisted transgastric cholecystectomy and secure endoscopic closure of the transgastric defect in a survival porcine model. Endoscopy 41:767–772
Arezzo A, Repici A, Kirschniak A, Schurr MO, Ho CN, Morino M (2008) New developments for endoscopic hollow organ closure in prospective of NOTES. Minim Invasive Ther Allied Technol 17:355–360
Kratt T, Kuper M, Traub F, Ho CN, Schurr MO, Konigsrainer A, Granderath FA, Kirschniak A (2008) Feasibility study for secure closure of natural orifice transluminal endoscopic surgery gastrotomies by using over-the-scope clips. Gastrointest Endosc 68:993–996
Schurr MO, Arezzo A, Ho CN, Anhoeck G, Buess G, Di Lorenzo N (2008) The OTSC clip for endoscopic organ closure in NOTES: device and technique. Minim Invasive Ther Allied Technol 17:262–266
Voermans RP, van Berge Henegouwen MI, Bemelman WA, Fockens P (2009) Novel over-the-scope clip system for gastrotomy closure in natural orifice transluminal endoscopic surgery (NOTES): an ex vivo comparison study. Endoscopy 41:1052–1055
von Renteln D, Schmidt A, Vassiliou MC, Gieselmann M, Caca K (2009) Natural orifice transluminal endoscopic surgery gastrotomy closure with an over-the-endoscope clip: a randomized, controlled porcine study (with videos). Gastrointest Endosc 70:732–739
von Renteln D, Vassiliou MC, Rothstein RI (2009) Randomized controlled trial comparing endoscopic clips and over-the-scope clips for closure of natural orifice transluminal endoscopic surgery gastrotomies. Endoscopy 41:1056–1061
Kirschniak A, Traub F, Kueper MA, Stuker D, Konigsrainer A, Kratt T (2007) Endoscopic treatment of gastric perforation caused by acute necrotizing pancreatitis using over-the-scope clips: a case report. Endoscopy 39:1100–1102
Repici A, Arezzo A, De Caro G, Morino M, Pagano N, Rando G, Romeo F, Del Conte G, Danese S, Malesci A (2009) Clinical experience with a new endoscopic over-the-scope clip system for use in the GI tract. Dig Liver Dis 41:406–410
Iacopini F, Di Lorenzo N, Altorio F, Schurr MO, Scozzarro A (2010) Over-the-scope clip closure of two chronic fistulas after gastric band penetration. World J Gastroenterol 16:1665–1669
Laine L, McQuaid KR (2009) Endoscopic therapy for bleeding ulcers: an evidence-based approach based on meta-analyses of randomized controlled trials. Clin Gastroenterol Hepatol 7:33–47 (quiz 1-2)
Raju GS, Gajula L (2004) Endoclips for GI endoscopy. Gastrointest Endosc 59:267–279
Lin HJ, Perng CL, Sun IC, Tseng GY (2003) Endoscopic haemoclip versus heater probe thermocoagulation plus hypertonic saline-epinephrine injection for peptic ulcer bleeding. Dig Liver Dis 35:898–902
Kim JI, Kim SS, Park S, Han J, Kim JK, Han SW, Choi KY, Chung IS, Chung KW, Sun HS (2003) Endoscopic hemoclipping using a transparent cap in technically difficult cases. Endoscopy 35:659–662
Lai YC, Yang SS, Wu CH, Chen TK (2000) Endoscopic hemoclip treatment for bleeding peptic ulcer. World J Gastroenterol 6:53–56
Choi KD, Jung HY, Lee GH, Oh TH, Jo JY, Song HJ, Hong SS, Kim JH (2008) Application of metal hemoclips for closure of endoscopic mucosal resection-induced ulcers of the stomach to prevent delayed bleeding. Surg Endosc 22:1882–1886
Disclosures
A. Kirschniak was cofounder of Ovesco Endoscopy AG, Tuebingen, Germany. N. Subotova, D. Zieker, Th. Kratt, and A. Königsrainer have no conflicts of interest or financial ties to disclose.
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Kirschniak, A., Subotova, N., Zieker, D. et al. The Over-The-Scope Clip (OTSC) for the treatment of gastrointestinal bleeding, perforations, and fistulas. Surg Endosc 25, 2901–2905 (2011). https://doi.org/10.1007/s00464-011-1640-2
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DOI: https://doi.org/10.1007/s00464-011-1640-2