Outcomes of Gastrointestinal Defect Closure with an Over-the-scope Clip System in a Multicenter Experience: An Analysis of a Successful Suction Method

Overview

Journal World J Gastroenterol

Publisher Baishideng Publishing Group

Specialty Gastroenterology

Date 2017 Mar 22

PMID 28321166

Citations 13

Authors

Hideki Kobara

Hirohito Mori

Shintaro Fujihara

Noriko Nishiyama

Taiga Chiyo

Takayoshi Yamada

Masao Fujiwara

Keiichi Okano

Yasuyuki Suzuki

Masayuki Murota

Yoshitaka Ikeda

Makoto Oryu

Mohamed AboEllail

Tsutomu Masaki

Affiliations

Soon will be listed here.

Abstract

Aim: To demonstrate the clinical outcomes of a multicenter experience and to suggest guidelines for choosing a suction method.

Methods: This retrospective study at 5 medical centers involved 58 consecutive patients undergoing over-the-scope clips (OTSCs) placement. The overall rates of technical success (TSR), clinical success (CSR), complications, and procedure time were analyzed as major outcomes. Subsequently, 56 patients, excluding two cases that used the Anchor device, were divided into two groups: 14 cases of simple suction (SS-group) and 42 cases using the Twin Grasper (TG-group). Secondary evaluation was performed to clarify the predictors of OTSC success.

Results: The TSR, CSR, complication rate, and median procedure time were 89.7%, 84.5%, 1.8%, and 8 (range 1-36) min, respectively, demonstrating good outcomes. However, significant differences were observed between the two groups in terms of the mean procedure time (5.9 min 14.1 min). The CSR of the SS- and TG-groups among cases with a maximum defect size ≤ 10 mm and immediate or acute refractory bleeding was 100%, which suggests that SS is a better method than TG in terms of time efficacy. The CSR in the SS-group (78.6%), despite the technical success of the SS method (TSR, 100%), tended to decrease due to delayed leakage compared to that in the TG-group (TSR, CSR; 88.1%), indicating that TG may be desirable for leaks and fistulae with defects of the entire layer.

Conclusion: OTSC system is a safe and effective therapeutic option for gastrointestinal defects. Individualized selection of the suction method based on particular clinical conditions may contribute to the improvement of OTSC success.

Citing Articles

Successful closure of a duodenal stump leak with an over-the-scope clip using double-balloon endoscope.

Kuwano T, Shimaoka S, Kusumoto H, Kishita H, Sakiyama T, Yamamoto S Endoscopy. 2024; 56(S 01):E1028-E1029.

PMID: 39577855 PMC: 11584285. DOI: 10.1055/a-2447-8139.

Advancements in endoscopic hemostasis for non-variceal upper gastrointestinal bleeding.

Li X, Fung B World J Gastrointest Endosc. 2024; 16(7):376-384.

PMID: 39072248 PMC: 11271718. DOI: 10.4253/wjge.v16.i7.376.

Outcomes of Endoscopic Intervention Using Over-the-Scope Clips for Anastomotic Leakage Involving Secondary Fistula after Gastrointestinal Surgery: A Japanese Multicenter Case Series.

Tada N, Kobara H, Tashima T, Fukui H, Asai S, Ichinona T Diagnostics (Basel). 2023; 13(18).

PMID: 37761364 PMC: 10528500. DOI: 10.3390/diagnostics13182997.

Endoscopic negative pressure therapy for duodenal leaks.

Wichmann D, Stuker D, Schweizer U, Senne M, Duckworth-Mothes B, Zerabruck E Front Surg. 2023; 10:1099457.

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A Single-Center Case Series of Endoscopically Treated Aorto-Gastrointestinal Fistula after Endovascular Aortic Repair: Surgery Is Still the Only Valid Solution.

Kubesch A, Waidmann O, Blumenstein I, Bechstein W, Friedrich-Rust M, Jung M Visc Med. 2021; 37(2):134-141.

PMID: 33981754 PMC: 8077538. DOI: 10.1159/000507821.

References

Huang C, Hess D, Lichtenstein D . Successful endoscopic management of postoperative GI fistula with fibrin glue injection: Report of two cases. Gastrointest Endosc. 2004; 60(3):460-3. DOI: 10.1016/s0016-5107(04)01724-9. View

Manta R, Manno M, Bertani H, Barbera C, Pigo F, Mirante V . Endoscopic treatment of gastrointestinal fistulas using an over-the-scope clip (OTSC) device: case series from a tertiary referral center. Endoscopy. 2011; 43(6):545-8. DOI: 10.1055/s-0030-1256196. View

Mori H, Kobara H, Nishiyama N, Fujihara S, Matsunaga T, Chiyo T . Rescue therapy with over-the-scope clip closure for a large postoperative colonic leak. Endoscopy. 2015; 47 Suppl 1 UCTN:E115-6. DOI: 10.1055/s-0034-1391251. View

Mori H, Kobara H, Kobayashi M, Muramatsu A, Nomura T, Hagiike M . Establishment of pure NOTES procedure using a conventional flexible endoscope: review of six cases of gastric gastrointestinal stromal tumors. Endoscopy. 2011; 43(7):631-4. DOI: 10.1055/s-0030-1256227. View

Surace M, Mercky P, Demarquay J, Gonzalez J, Dumas R, Ah-Soune P . Endoscopic management of GI fistulae with the over-the-scope clip system (with video). Gastrointest Endosc. 2011; 74(6):1416-9. DOI: 10.1016/j.gie.2011.08.011. View

Nishiyama N, Mori H, Kobara H, Rafiq K, Fujihara S, Kobayashi M . Efficacy and safety of over-the-scope clip: including complications after endoscopic submucosal dissection. World J Gastroenterol. 2013; 19(18):2752-60. PMC: 3653149. DOI: 10.3748/wjg.v19.i18.2752. View

Kobara H, Mori H, Rafiq K, Fujihara S, Nishiyama N, Kato K . Successful endoscopic treatment of Boerhaave syndrome using an over-the-scope clip. Endoscopy. 2014; 46 Suppl 1 UCTN:E82-3. DOI: 10.1055/s-0032-1326454. View

Albert J, Friedrich-Rust M, Woeste G, Strey C, Bechstein W, Zeuzem S . Benefit of a clipping device in use in intestinal bleeding and intestinal leakage. Gastrointest Endosc. 2011; 74(2):389-97. DOI: 10.1016/j.gie.2011.03.1128. View

Manta R, Galloro G, Mangiavillano B, Conigliaro R, Pasquale L, Arezzo A . Over-the-scope clip (OTSC) represents an effective endoscopic treatment for acute GI bleeding after failure of conventional techniques. Surg Endosc. 2013; 27(9):3162-4. DOI: 10.1007/s00464-013-2871-1. View

10.

Kirschniak A, Kratt T, Stuker D, Braun A, Schurr M, Konigsrainer A . A new endoscopic over-the-scope clip system for treatment of lesions and bleeding in the GI tract: first clinical experiences. Gastrointest Endosc. 2007; 66(1):162-7. DOI: 10.1016/j.gie.2007.01.034. View

11.

Kothari T, Haber G, Sonpal N, Karanth N . The over-the-scope clip system--a novel technique for gastrocutaneous fistula closure: the first North American experience. Can J Gastroenterol. 2012; 26(4):193-5. PMC: 3354887. DOI: 10.1155/2012/452340. View

12.

Law R, Wong Kee Song L, Irani S, Baron T . Immediate technical and delayed clinical outcome of fistula closure using an over-the-scope clip device. Surg Endosc. 2014; 29(7):1781-6. DOI: 10.1007/s00464-014-3860-8. View

13.

Schecter W, Hirshberg A, Chang D, Harris H, Napolitano L, Wexner S . Enteric fistulas: principles of management. J Am Coll Surg. 2009; 209(4):484-91. DOI: 10.1016/j.jamcollsurg.2009.05.025. View

14.

Mercky P, Gonzalez J, Bonin E, Emungania O, Brunet J, Grimaud J . Usefulness of over-the-scope clipping system for closing digestive fistulas. Dig Endosc. 2014; 27(1):18-24. DOI: 10.1111/den.12295. View

15.

Lamazza A, Fiori E, Sterpetti A . Endoscopic placement of self-expandable metal stents for treatment of rectovaginal fistulas after colorectal resection for cancer. Gastrointest Endosc. 2014; 79(6):1025-7. DOI: 10.1016/j.gie.2014.01.010. View

16.

Mori H, Kobara H, Kazi R, Fujihara S, Nishiyama N, Masaki T . Balloon-armed mechanical counter traction and double-armed bar suturing systems for pure endoscopic full-thickness resection. Gastroenterology. 2014; 147(2):278-80.e1. DOI: 10.1053/j.gastro.2014.06.030. View

17.

Fujihara S, Mori H, Kobara H, Nishiyama N, Ayaki M, Nakatsu T . Use of an over-the-scope clip and a colonoscope for complete hemostasis of a duodenal diverticular bleed. Endoscopy. 2015; 47 Suppl 1 UCTN:E236-7. DOI: 10.1055/s-0034-1392212. View

18.

Martinek J, Ryska O, Tuckova I, Filipkova T, Dolezel R, Juhas S . Comparing over-the-scope clip versus endoloop and clips (KING closure) for access site closure: a randomized experimental study. Surg Endosc. 2012; 27(4):1203-10. DOI: 10.1007/s00464-012-2576-x. View

19.

Jirapinyo P, Watson R, Thompson C . Use of a novel endoscopic suturing device to treat recalcitrant marginal ulceration (with video). Gastrointest Endosc. 2012; 76(2):435-9. DOI: 10.1016/j.gie.2012.03.681. View

20.

Gotoda T, Yamamoto H, Soetikno R . Endoscopic submucosal dissection of early gastric cancer. J Gastroenterol. 2006; 41(10):929-42. DOI: 10.1007/s00535-006-1954-3. View