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Doyle WN, Netzley A, Mhaskar R, Diab ARF, Ganam S, Sujka J, DuCoin C, Docimo S. Endoscopic closure techniques of bariatric surgery complications: a meta-analysis. Surg Endosc 2024; 38:2894-2899. [PMID: 38630177 DOI: 10.1007/s00464-024-10799-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 03/10/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Leaks following bariatric surgery, while rare, are potentially fatal due to risk of peritonitis and sepsis. Anastomotic leaks and gastro-gastric fistulae following Roux-En-Y gastric bypass (RYGB) as well as staple line leaks after sleeve gastrectomy have historically been treated multimodally with surgical drainage, aggressive antibiotic therapy, and more recently, endoscopically. Endoscopic clipping using over-the-scope clips and endoscopic suturing are two of the most common approaches used to achieve full thickness closure. METHODS A systematic literature search was performed in PubMed to identify articles on the use of endoscopic clipping or suturing for the treatment of leaks and fistulae following bariatric surgery. Studies focusing on stents, and those that incorporated multiple closure techniques simultaneously, were excluded. Literature review and meta-analysis were performed with the PRISMA guidelines. RESULTS Five studies with 61 patients that underwent over-the-scope clip (OTSC) closure were included. The pooled proportion of successful closure across the studies was 81.1% (95% CI 67.3 to 91.7). The successful closure rates were homogeneous (I2 = 39%, p = 0.15). Three studies with 92 patients that underwent endoscopic suturing were included. The weighted pooled proportion of successful closure across the studies was shown to be 22.4% (95% CI 14.6 to 31.3). The successful closure rates were homogeneous (I2 = 0%, p = 0.44). Three of the studies, totaling 34 patients, examining OTSC deployment reported data for reintervention rate. The weighted pooled proportion of reintervention across the studies was 35.0% (95% CI 11.7 to 64.7). We noticed statistically significant heterogeneity (I2 = 68%, p = 0.04). One study, with 20 patients examining endoscopic suturing, reported rate of repeat intervention 60%. CONCLUSION Observational reports show that patients managed with OTSC were more likely to experience healing of their defect than those managed with endoscopic suturing. Larger controlled studies comparing different closure devices for bariatric leaks should be carried out to better understand the ideal endoscopic approach to these complications.
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Affiliation(s)
- William N Doyle
- University of South Florida Morsani College of Medicine, Tampa, FL, USA.
| | - Alexander Netzley
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Rahul Mhaskar
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Abdul-Rahman F Diab
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
- Department of Gastrointestinal Surgery, Tampa General Hospital, Tampa, FL, USA
| | - Samer Ganam
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
- Department of Gastrointestinal Surgery, Tampa General Hospital, Tampa, FL, USA
| | - Joseph Sujka
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
- Department of Gastrointestinal Surgery, Tampa General Hospital, Tampa, FL, USA
| | - Christopher DuCoin
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
- Department of Gastrointestinal Surgery, Tampa General Hospital, Tampa, FL, USA
| | - Salvatore Docimo
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
- Department of Gastrointestinal Surgery, Tampa General Hospital, Tampa, FL, USA
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Mendoza J, Tovar G, Álvarez R. Hepatoduodenal fistula closure diagnosed and characterized Ecoendoscopically (EUS) and managed by OTSC CLIP OVESCO: A case report. Int J Surg Case Rep 2021; 84:106093. [PMID: 34146787 PMCID: PMC8220336 DOI: 10.1016/j.ijscr.2021.106093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/17/2021] [Accepted: 06/05/2021] [Indexed: 01/17/2023] Open
Abstract
Introduction Gastrointestinal (GI) tract perforations are a significant source of morbidity in clinical practice; therefore, an early diagnosis is fundamental for early management. In management, surgery is the definitive therapy; however, there is evidence of a strong response to conservative measurements. Presentation of case A 53-year-old man known for a laparoscopic cholecystectomy with difficult access and postoperative complications was admitted to our emergency department due to a five-day clinical history comprising acute abdominal pain and feverish peaks up to 38.4 °C. Diagnosis methods CT and NMR were performed but did not lead to a clear diagnosis. Therefore, a EUS was performed observing an anechoic path that communicates the duodenal wall with a right subhepatic collection that was in contact with the proximal bile duct, thickening its walls. A 5 mm fistulous orifice was found. The hepatoduodenal fistula was close endoscopically with the over-the-scope-clip OVESCO OTSC. Post endoscopic closure course was uneventful. Discussion Duodenal fistulae are considered one of the most serious complications in gastrointestinal surgery, when conventional diagnosis methods do not permit the clinicians to get either a medical diagnosis or the management; the EUS can. Advances in interventional endoscopic techniques offer an alternative management for the closure of GI fistulae. Conclusion Whenever the presence of an organized fistula is clinically suspected, EUS can be considered a useful tool that allows not only the characterization of the fistulous path and but also the definition of the minimally invasive endoscopic treatment. Duodenal fistulae are considered one of the most serious complications in gastrointestinal surgery. Whenever the presence of an organized intestinal fistula is clinically suspected, EUS can be considered a useful tool that allows characterizing the fistulous path and defining the minimally invasive endoscopic treatment.
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Affiliation(s)
- Jairo Mendoza
- Division of Gastroenterology and digestive surgery, FOSCAL Clinic, Floridablanca, Santander, Colombia.
| | - Germán Tovar
- Division of Gastroenterology and digestive surgery, FOSCAL Clinic, Floridablanca, Santander, Colombia
| | - Rubén Álvarez
- Division of Gastroenterology and digestive surgery, FOSCAL Clinic, Floridablanca, Santander, Colombia
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Endoscopic closure of gastrointestinal perforations and fistulas using the Ovesco Over-The-Scope Clip system at a tertiary care hospital center. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2019; 84:263-266. [PMID: 31014750 DOI: 10.1016/j.rgmx.2018.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 09/27/2018] [Accepted: 10/29/2018] [Indexed: 12/19/2022]
Abstract
INTRODUCTION AND AIM Enteric perforations and fistulas are difficult to manage due to comorbidities, poor nutritional status, and anatomic challenges related to multiple interventions in those patients. The use of endoscopic methods as a nonsurgical approach is increasing. The aim of the present study was to describe the clinical experience with the use of the Ovesco Over-The-Scope Clip system in the closure of perforations, fistulas, and other indications in the digestive tract at a tertiary care hospital center. MATERIALS AND METHODS A case series was carried out on patients that underwent lesion closure with the Ovesco clip, within the time frame of January 2015 to December 2017. RESULTS The Ovesco clip was used for closure in 14 patients ranging in age from 21-90 years, with different indications: iatrogenic perforations; anastomotic leaks and fistulas; tracheoesophageal fistulas; and esophagogastric perforation. Technical success was achieved in 100% of the patients and clinical success in 78.57%. No complications were reported. CONCLUSIONS The Ovesco Over-The-Scope Clip system is a safe and effective method for managing gastrointestinal acute perforations and fistulas.
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Endoscopic closure of gastrointestinal perforations and fistulas using the Ovesco Over-The-Scope Clip system at a tertiary care hospital center. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2019. [DOI: 10.1016/j.rgmxen.2018.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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Mosquera Klinger G, Holguín-Cardona A. Endoscopic closure of tracheoesophageal fistula for tuberculosis with an over-the-scope-clip. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2019; 110:594-596. [PMID: 29931992 DOI: 10.17235/reed.2018.5563/2018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Surgical management has been the main approach for enteral fistulae. This approach is usually complex due to comorbidities, a wasted nutritional state and anatomical difficulties related to prior multiple interventions. Therefore, endoscopic methods such as clips, self-expanding metal stent (SEMS) and recently, the over scope clip (OTSC®) are increasing in popularity and use. Herein, we present the case of a patient with a HIV infection who was admitted due to respiratory symptoms. Radiological and microbiological studies documented a tracheoesophageal fistula due to tuberculosis (TB) and cytomegalovirus (CMV) infection. Therefore, an esophageal fully-covered stent was placed, which migrated into the stomach. The thoracic surgeons considered an esophagectomy with gastric ascent and muscle patch in the trachea. However, due to his poor nutritional status and comorbidity, an OTSC was placed to treat the fistulae. The patient also received medical treatment with anti-tuberculotics and anti-retrovirals.
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Affiliation(s)
| | - Andrea Holguín-Cardona
- Unidad de gastroenterología y endoscopia digestiva, Hospital Pablo Tobón Uribe , Colombia
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García-García ML, Jiménez-Ballester MÁ, Girela-Baena E, Aguayo-Albasini JL. Abdominal wall abscess secondary to colonoscopic polypectomy. Radiological management. GASTROENTEROLOGIA Y HEPATOLOGIA 2016; 40:463-464. [PMID: 27717504 DOI: 10.1016/j.gastrohep.2016.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 06/06/2016] [Accepted: 06/16/2016] [Indexed: 10/20/2022]
Affiliation(s)
- María Luisa García-García
- Servicio de Cirugía General y Radiología, Hospital Universitario Morales-Meseguer, Instituto de Investigación IMIB-Arrixaca, Universidad de Murcia, Murcia, España; Mare Nostrum International Excellence Campus, Murcia, España
| | - Miguel Ángel Jiménez-Ballester
- Servicio de Cirugía General y Radiología, Hospital Universitario Morales-Meseguer, Instituto de Investigación IMIB-Arrixaca, Universidad de Murcia, Murcia, España; Mare Nostrum International Excellence Campus, Murcia, España.
| | - Enrique Girela-Baena
- Servicio de Cirugía General y Radiología, Hospital Universitario Morales-Meseguer, Instituto de Investigación IMIB-Arrixaca, Universidad de Murcia, Murcia, España; Mare Nostrum International Excellence Campus, Murcia, España
| | - José Luis Aguayo-Albasini
- Servicio de Cirugía General y Radiología, Hospital Universitario Morales-Meseguer, Instituto de Investigación IMIB-Arrixaca, Universidad de Murcia, Murcia, España; Mare Nostrum International Excellence Campus, Murcia, España
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Sánchez-Valle AA, Cruz-Zarate A, Rodríguez-Ruiz G. Manejo exitoso de perforación gástrica secundaria a plicatura de curvatura mayor laparoscópica con gastrostomía endoscópica percutánea con avance yeyunal y sellador de fibrina. ENDOSCOPIA 2016. [DOI: 10.1016/j.endomx.2016.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Fernandes C, Pinho R, Ribeiro I, Silva J, Ponte A, Vale S, Maciel J, Carvalho J. Endoscopic management of non-iatrogenic gastrointestinal perforations--A case series. GASTROENTEROLOGIA Y HEPATOLOGIA 2015; 39:219-20. [PMID: 25703071 DOI: 10.1016/j.gastrohep.2015.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Accepted: 01/08/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Carlos Fernandes
- Department of Gastroenterology, Centro Hospitalar de Vila Nova de Gaia, Vila Nova Gaia, Portugal.
| | - Rolando Pinho
- Department of Gastroenterology, Centro Hospitalar de Vila Nova de Gaia, Vila Nova Gaia, Portugal
| | - Iolanda Ribeiro
- Department of Gastroenterology, Centro Hospitalar de Vila Nova de Gaia, Vila Nova Gaia, Portugal
| | - Joana Silva
- Department of Gastroenterology, Centro Hospitalar de Vila Nova de Gaia, Vila Nova Gaia, Portugal
| | - Ana Ponte
- Department of Gastroenterology, Centro Hospitalar de Vila Nova de Gaia, Vila Nova Gaia, Portugal
| | - Sílvio Vale
- Department of Surgery, Centro Hospitalar de Vila Nova de Gaia, Vila Nova Gaia, Portugal
| | - Jorge Maciel
- Department of Surgery, Centro Hospitalar de Vila Nova de Gaia, Vila Nova Gaia, Portugal
| | - João Carvalho
- Department of Gastroenterology, Centro Hospitalar de Vila Nova de Gaia, Vila Nova Gaia, Portugal
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Boumitri C, Kumta NA, Patel M, Kahaleh M. Closing perforations and postperforation management in endoscopy: duodenal, biliary, and colorectal. Gastrointest Endosc Clin N Am 2015; 25:47-54. [PMID: 25442957 DOI: 10.1016/j.giec.2014.09.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Early recognition of adverse events arising from endoscopy is essential. In some cases the injury can be viewed clearly during the procedure, and immediate action should be taken to repair the defect endoscopically if feasible. If perforation is unclear, imaging can be used to confirm the diagnosis. Surgical intervention is not always necessary; however, a surgical consultation for backup is essential. Selective cases can be managed conservatively or endoscopically with successful outcomes. Early recognition and intervention, input from specialist colleagues, and communication with the patient and family are keys to successfully managing the event.
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Affiliation(s)
- Christine Boumitri
- Department of Medicine, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY 10305, USA
| | - Nikhil A Kumta
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, 1305 York Avenue, 4th Floor, New York, NY 10021, USA
| | - Milan Patel
- Division of Gastroenterology, Robert Wood Johnson Medical School, 501 Fellowship Road, Mount Laurel, NJ 08054, USA
| | - Michel Kahaleh
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, 1305 York Avenue, 4th Floor, New York, NY 10021, USA.
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Sliker LJ, Ciuti G. Flexible and capsule endoscopy for screening, diagnosis and treatment. Expert Rev Med Devices 2014; 11:649-66. [PMID: 25148269 DOI: 10.1586/17434440.2014.941809] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Endoscopy dates back to the 1860s, but many of the most significant advancements have been made within the past decade. With the integration of robotics, the ability to precisely steer and advance traditional flexible endoscopes has been realized, reducing patient pain and improving clinician ergonomics. Additionally, wireless capsule endoscopy, a revolutionary alternative to traditional scopes, enables inspection of the digestive system with minimal discomfort for the patient or the need for sedation, mitigating some of the risks of flexible endoscopy. This review presents a research update on robotic endoscopic systems, including both flexible scope and capsule technologies, detailing actuation methods and therapeutic capabilities. A future perspective on endoscopic potential for screening, diagnostic and therapeutic gastrointestinal procedures is also presented.
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Affiliation(s)
- Levin J Sliker
- Department of Mechanical Engineering, University of Colorado, 114 ECME, Engineering Center, 1111 Engineering Drive, Boulder, CO 80309-0427, USA
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Pérez-Cuadrado-Robles E, Flores-Pastor B, Bebia P, Pérez-Cuadrado-Martínez E, Aguayo-Albasini JL. Endoscopic management of a perforation during diagnostic colonoscopy using OVESCO(®) clip. Cir Esp 2014; 94:e25-7. [PMID: 24768280 DOI: 10.1016/j.ciresp.2014.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 03/02/2014] [Accepted: 03/04/2014] [Indexed: 11/24/2022]
Affiliation(s)
| | - Benito Flores-Pastor
- Servicio de Cirugía General, Hospital General Universitario JM Morales Meseguer , Murcia, España.
| | - Paloma Bebia
- Servicio de Digestivo, Hospital General Universitario JM Morales Meseguer , Murcia, España
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Endoscopic treatment of iatrogenic gastrointestinal perforations: an overview. Dig Liver Dis 2014; 46:195-203. [PMID: 24210991 DOI: 10.1016/j.dld.2013.09.024] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 08/28/2013] [Accepted: 09/10/2013] [Indexed: 02/06/2023]
Abstract
In the past, the treatment of iatrogenic gastrointestinal perforations was limited to surgical management or to medical observation. Natural Orifice Transluminal Endoscopic Surgery (NOTES) has paved the way towards the development of reliable endoscopic closure techniques, which can be applicable in accidental perforations of the gastrointestinal tract. When endoscopic treatment is feasible, hemoclips are preferred in smaller perforations, while over-the-scope-clips or a combination of hemoclips, endoloops, and glue are used in larger ones. Endoscopic stitching is rarely utilized, and endoscopic stapling has been practically abandoned. The use of self-expandable covered stents can be considered in the esophagus and duodenum. Broad spectrum antibiotics are recommended in most cases. Clinical follow-up in a medico-surgical unit is mandatory and surgical intervention should not be delayed more than 24h if clinical or biological worsening occurs. Imaging with oral contrast medium is advisable before resumption of oral feeding in the case of large perforations.
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Gallego Pérez B, Rodríguez Gil FJ, García Belmonte D, Marín Bernabé CM, Martínez Crespo JJ, Martínez Prieto C. [Treatment of a gastrocutaneous fistula with the OVESCO System after gastrostomy button displacement]. GASTROENTEROLOGIA Y HEPATOLOGIA 2012; 35:609-10. [PMID: 22551570 DOI: 10.1016/j.gastrohep.2012.01.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2012] [Accepted: 01/26/2012] [Indexed: 11/18/2022]
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