Efficacy and Safety of Over-the-scope Clip: Including Complications After Endoscopic Submucosal Dissection

Overview

Journal World J Gastroenterol

Publisher Baishideng Publishing Group

Specialty Gastroenterology

Date 2013 May 21

PMID 23687412

Citations 51

Authors

Noriko Nishiyama

Hirohito Mori

Hideki Kobara

Kazi Rafiq

Shintarou Fujihara

Mitsuyoshi Kobayashi

Makoto Oryu

Tsutomu Masaki

Affiliations

Soon will be listed here.

Abstract

Aim: To retrospectively review the results of over-the-scope clip (OTSC) use in our hospital and to examine the feasibility of using the OTSC to treat perforations after endoscopic submucosal dissection (ESD).

Methods: We enrolled 23 patients who presented with gastrointestinal (GI) bleeding, fistulae and perforations and were treated with OTSCs (Ovesco Endoscopy GmbH, Tuebingen, Germany) between November 2011 and September 2012. Maximum lesion size was defined as lesion diameter. The number of OTSCs to be used per patient was not decided until the lesion was completely closed. We used a twin grasper (Ovesco Endoscopy GmbH, Tuebingen, Germany) as a grasping device for all the patients. A 9 mm OTSC was chosen for use in the esophagus and colon, and a 10 mm device was used for the stomach, duodenum and rectum. The overall success rate and complications were evaluated, with a particular emphasis on patients who had undergone ESD due to adenocarcinoma. In technical successful cases we included not only complete closing by using OTSCs, but also partial closing where complete closure with OTSCs is almost difficult. In overall clinical successful cases we included only complete closing by using only OTSCs perfectly. All the OTSCs were placed by 2 experienced endoscopists. The sites closed after ESD included not only the perforation site but also all defective ulcers sites.

Results: A total of 23 patients [mean age 77 years (range 64-98 years)] underwent OTSC placement during the study period. The indications for OTSC placement were GI bleeding (n = 9), perforation (n = 10), fistula (n = 4) and the prevention of post-ESD duodenal artificial ulcer perforation (n = 1). One patient had a perforation caused by a glycerin enema, after which a fistula formed. Lesion closure using the OTSC alone was successful in 19 out of 23 patients, and overall success rate was 82.6%. A large lesion size (greater than 20 mm) and a delayed diagnosis (more than 1 wk) were the major contributing factors for the overall unsuccessful clinical cases. The location of the unsuccessful lesion was in the stomach. The median operation time in the successful cases was 18 min, and the average observation time was 67 d. During the observation period, none of the patients experienced any complications associated with OTSC placement. In addition, we successfully used the OTSC to close the perforation site after ESD in 6 patients. This was a single-center, retrospective study with a small sample size.

Conclusion: The OTSC is effective for treating GI bleeding, fistulae as well as perforations, and the OTSC technique proofed effective treatment for perforation after ESD.

Citing Articles

Effective and Secure Closure after Duodenal Endoscopic Submucosal Dissection: Combination of Endoscopic Ligation with O-Ring Closure and Over-the-Scope Clip.

Nakatani K, Kobara H, Nishiyama N, Fujihara S, Tada N, Koduka K J Clin Med. 2023; 12(13).

PMID: 37445273 PMC: 10342600. DOI: 10.3390/jcm12134238.

Endoscopic tacking system as a novel tissue approximation measure for very large EMR defects.

Keihanian T, Othman M, Jawaid S VideoGIE. 2022; 7(11):419-422.

PMID: 36407047 PMC: 9669601. DOI: 10.1016/j.vgie.2022.08.002.

Laparoscopic Endoscopic Cooperative Surgery Using Open-Window Suturing Technique for Treating Non-ampullary Superficial Duodenal Neoplasms Located on the Pancreatic Side.

Kanaji S, Morita Y, Kudo T, Yamada K, Kato T, Sakai A J Gastrointest Surg. 2022; 26(11):2266-2273.

PMID: 35882757 DOI: 10.1007/s11605-022-05424-8.

Over-the-Scope Clip Applications as First-Line Therapy in the Treatment of Upper Non-variceal Gastrointestinal Bleeding, Perforations, and Fistulas.

Qiu J, Xu J, Zhang Y, Liao F, Zhu Z, Shu X Front Med (Lausanne). 2022; 9:753956.

PMID: 35242770 PMC: 8886136. DOI: 10.3389/fmed.2022.753956.

Over-the-Scope Clip in the Treatment of Gastrointestinal Leaks and Perforations.

Wei M, Ahn J, Friedland S Clin Endosc. 2021; 54(6):798-804.

PMID: 34872236 PMC: 8652163. DOI: 10.5946/ce.2021.250.

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