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Sehmbey G, Srinivasan I, Chuang KY. Acute Pancreatitis Due to Clipping of the Ampulla With Over-The-Scope Clip as a Complication of Bleeding Duodenal Ulcer Treatment. Cureus 2020; 12:e8963. [PMID: 32656042 PMCID: PMC7341457 DOI: 10.7759/cureus.8963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 07/02/2020] [Indexed: 11/21/2022] Open
Abstract
Over-the-scope clips (OTSC) (Ovesco, Tübingen, Germany) are commonly used for closure of bowel perforations, fistulas and to achieve hemostasis. This device is attached to the endoscope and delivers a variety of clips, based on diameter and depth, that works through tissue approximation. Complications including local inflammation, ulcers, or obstruction can occur. When the clip is misplaced or OTSC-associated complications occur, OTSC removal may be indicated. We present a case of a patient who presented to our hospital with upper gastrointestinal (GI) bleeding. OTSC was used to achieve hemostasis, however, the clip was misplaced over the ampulla of Vater. remOVE system (Ovesco, Tübingen, Germany) was used to remove the misplaced clip.
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Affiliation(s)
- Gurbir Sehmbey
- Internal Medicine, Banner University Medical Center, Phoenix, USA
- Internal Medicine, University of Arizona College of Medicine - Phoenix, Phoenix, USA
| | - Indu Srinivasan
- Gastroenterology, Valleywise Health Medical Center, Phoenix, USA
| | - Keng-Yu Chuang
- Internal Medicine/Gastroenterology, Valleywise Health Medical Center, Phoenix, USA
- Internal Medicine/Gastroenterology, Creighton University School of Medicine-Phoenix Program, Phoenix, USA
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2
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Abstract
The over-the-scope clip is safe and efficacious and has become the preferred device of choice for the treatment of complex gastrointestinal bleeding, perforation, and gastrointestinal leaks. With its widespread adoption in clinical practice, information on complications associated with over-the-scope clip use is emerging. Nonetheless, the overall complication rate is still very low. Most of the reported complications have been related to the technique rather than the actual device and could likely be prevented with proper technique. In this article, the authors summarize the complications associated with over-the-scope clip use and provide guidance on safety measure to mitigate them.
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Hu J, Yang Y, Ge N, Wang S, Guo J, Liu X, Wang G, Sun S. Long-term assessment of over-the-scope clip (OTSC) behavior after gastric application. MINIM INVASIV THER 2019; 29:86-89. [PMID: 31144550 DOI: 10.1080/13645706.2019.1590417] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Background: The aim of this study was to assess the long-term behavior of the over-the-scope clip (OTSC) after gastric application.Material and methods: A database of all patients who had OTSC placement with regular follow-up at a tertiary hospital between November 2013 and September 2016 was retrospectively analyzed. The incidence, time, and related adverse events of clip attachment and detachment were recorded. The relationship between the position of the clip and detachment was assessed by Fisher's exact test.Results: Seventy-two patients who had gastric OTSC placement due to iatrogenic perforations by endoscopic interventions were included in the study. The overall incidence of clip detachment was 27.8% (20/72). Fisher's exact test confirmed a significant association between clip detachment rate and clip position (p = .005): cardia 50% (3/6); gastric fundus 13.2% (5/38); gastric body 75% (9/16); and gastric antrum 25% (3/12). Except for one patient (5%; 1/20) who experienced minor gastric hemorrhage, there were no complications related to spontaneous clip detachment. There was no delayed bleeding, perforation, or obstruction due to clips staying in place in the long-term.Conclusions: Long-term gastric clip attachment appears to be safe even if spontaneous detachment occurs.
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Affiliation(s)
- Jinlong Hu
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yang Yang
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Nan Ge
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Sheng Wang
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jintao Guo
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiang Liu
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Guoxin Wang
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Siyu Sun
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang, China
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Kobara H, Mori H, Nishiyama N, Fujihara S, Okano K, Suzuki Y, Masaki T. Over-the-scope clip system: A review of 1517 cases over 9 years. J Gastroenterol Hepatol 2019; 34:22-30. [PMID: 30069935 DOI: 10.1111/jgh.14402] [Citation(s) in RCA: 110] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 07/12/2018] [Accepted: 07/24/2018] [Indexed: 12/13/2022]
Abstract
Rescue therapy for gastrointestinal (GI) refractory bleeding, perforation, and fistula has traditionally required surgical interventions owing to the limited performance of conventional endoscopic instruments and techniques. An innovative clipping system, the over-the-scope clip (OTSC), may play an important role in rescue therapy. This innovative device is proposed as the final option in endoscopic treatment. The device presents several advantages including having a powerful sewing force for closure of GI defects using a simple mechanism and also having an innovative feature, whereby a large defect and fistula can be sealed using accessory forceps. Consequently, it is able to provide outstanding clinical effects for rescue therapy. This review clarifies the current status and limitations of OTSC according to different indications of GI refractory disease, including refractory bleeding, perforation, fistula, and anastomotic dehiscence. An extensive literature search identified studies reported 10 or more cases in which the OTSC system was applied. A total of 1517 cases described in 30 articles between 2010 and 2018 were retrieved. The clinical success rates and complications were calculated overall and for each indication. The average clinical success rate was 78% (n = 1517) overall, 85% for bleeding (n = 559), 85% (n = 351) for perforation, 52% (n = 388) for fistula, 66% (n = 97) for anastomotic dehiscence, and 95% (n = 122) for other conditions, respectively. The overall and severe OTSC-associated complications were 1.7% (n = 23) and 0.59% (n = 9), respectively. This review concludes that the OTSC system may serve as a safe and productive device for GI refractory diseases, albeit with limited success for fistula.
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Affiliation(s)
- Hideki Kobara
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Takamatsu, Japan
| | - Hirohito Mori
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Takamatsu, Japan
| | - Noriko Nishiyama
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Takamatsu, Japan
| | - Shintaro Fujihara
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Takamatsu, Japan
| | - Keiichi Okano
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Takamatsu, Japan
| | - Yasuyuki Suzuki
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Takamatsu, Japan
| | - Tsutomu Masaki
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Takamatsu, Japan
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Liu S, Jacobsen GR, Sandler BJ, Savides TJ, Fehmi S, Fuchs H, Luo RB, Delong JC, Coker AM, Houghton C, Horgan S. Preventing Rescue Surgeries by Endoscopic Clipping: A Valuable Resource in the Surgeon's Toolbox. J Laparoendosc Adv Surg Tech A 2018; 28:439-444. [PMID: 29432050 DOI: 10.1089/lap.2017.0167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
AIM Over-the-scope-clip (OTSC) System is a relatively new endoluminal intervention for gastrointestinal (GI) leaks, fistulas, and bleeding. Here, we present a single center experience with the device over the course of 4 years. METHODS Retrospective chart review was conducted for patients who received endoscopic OTSC treatment. Primary outcome is the resolution of the original indication for clip placement. Secondary outcomes are complications and time to resolution. RESULTS Forty-one patients underwent treatment with the OTSC system from 2011 to 2015 with average follow-up of 152 days. The average age is 53.7. The most common site of clip placement was in the stomach (44%). Clips were placed after surgical complication for 28 patients (68%), endoscopic complications for 8 patients (19%), and spontaneous presentation in 5 patients (12%). Technical success was achieved in all patients. Overall, 34 patients (83%) were successfully treated. Nine patients required multiple clips and three patients required additional treatment modalities after OTSC. Four patients used the OTSC as a bridging therapy to surgery. Using OTSC for palliation versus nonpalliative indications was associated with lower rates of treatment success (50% versus 86%, P = .028). Using OTSC for symptoms <6 months had higher rates of treatment success than those experiencing longer symptoms (88% versus 65%, P = .045). There were no major morbidities or mortalities directly associated with the OTSC system. Complications from clip use were pain in two patients (5%) and hematemesis in one patient (3%). CONCLUSIONS The OTSC System can be a very successful treatment for iatrogenic or spontaneous GI leaks and bleeds. Treatment success is more likely in patients treated within 6 months of diagnosis and less likely to when used for palliation. It was also successfully used as bridging therapy in several patients.
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Affiliation(s)
- Shanglei Liu
- 1 Department of Surgery, Center for the Future of Surgery, University of California at San Diego , San Diego, California
| | - Garth R Jacobsen
- 1 Department of Surgery, Center for the Future of Surgery, University of California at San Diego , San Diego, California
| | - Bryan J Sandler
- 1 Department of Surgery, Center for the Future of Surgery, University of California at San Diego , San Diego, California
| | - Thomas J Savides
- 2 Department of Gastroenterology, University of California at San Diego , San Diego, California
| | - Syed Fehmi
- 2 Department of Gastroenterology, University of California at San Diego , San Diego, California
| | - Hans Fuchs
- 1 Department of Surgery, Center for the Future of Surgery, University of California at San Diego , San Diego, California
| | - Ran B Luo
- 1 Department of Surgery, Center for the Future of Surgery, University of California at San Diego , San Diego, California
| | - Jonathan C Delong
- 1 Department of Surgery, Center for the Future of Surgery, University of California at San Diego , San Diego, California
| | - Alisa M Coker
- 1 Department of Surgery, Center for the Future of Surgery, University of California at San Diego , San Diego, California
| | - Caitlin Houghton
- 1 Department of Surgery, Center for the Future of Surgery, University of California at San Diego , San Diego, California
| | - Santiago Horgan
- 1 Department of Surgery, Center for the Future of Surgery, University of California at San Diego , San Diego, California
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Pines G, Bar I, Elami A, Sapojnikov S, Hikri O, Ton D, Mosenkis B, Melzer E. Modified Endoscopic Vacuum Therapy for Nonhealing Esophageal Anastomotic Leak: Technique Description and Review of Literature. J Laparoendosc Adv Surg Tech A 2018; 28:33-40. [DOI: 10.1089/lap.2017.0318] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Guy Pines
- Department of Thoracic Surgery, Kaplan Medical Center and The Hebrew University School of Medicine, Rehovot, Israel
| | - Ilan Bar
- Department of Thoracic Surgery, Kaplan Medical Center and The Hebrew University School of Medicine, Rehovot, Israel
| | - Amir Elami
- Department of Thoracic Surgery, Kaplan Medical Center and The Hebrew University School of Medicine, Rehovot, Israel
| | - Shimon Sapojnikov
- Department of Surgery, Kaplan Medical Center and The Hebrew University School of Medicine, Rehovot, Israel
| | - Ofir Hikri
- Department of Thoracic Surgery, Kaplan Medical Center and The Hebrew University School of Medicine, Rehovot, Israel
| | - Dennis Ton
- Department of Invasive Radiology, Kaplan Medical Center and The Hebrew University School of Medicine, Rehovot, Israel
| | - Bruce Mosenkis
- Department of Gastroenterology and Liver Diseases, Kaplan Medical Center and The Hebrew University School of Medicine, Rehovot, Israel
| | - Ehud Melzer
- Department of Gastroenterology and Liver Diseases, Kaplan Medical Center and The Hebrew University School of Medicine, Rehovot, Israel
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Kapadia S, Nagula S, Kumta NA. Argon plasma coagulation for successful fragmentation and removal of an over-the-scope clip. Dig Endosc 2017; 29:820-821. [PMID: 28741735 DOI: 10.1111/den.12925] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 07/14/2017] [Indexed: 01/05/2023]
Affiliation(s)
- Samir Kapadia
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Satish Nagula
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Nikhil A Kumta
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, USA
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Caputo A, Schmidt A, Caca K, Bauerfeind P, Schostek S, Ho CN, Gottwald T, Schurr MO. Efficacy and safety of the remOVE System for OTSC ® and FTRD ® clip removal: data from a PMCF analysis. MINIM INVASIV THER 2017; 27:138-142. [PMID: 28608741 DOI: 10.1080/13645706.2017.1335643] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The remOVE System (Ovesco Endoscopy AG, Tuebingen, Germany) is a medical device for the endoscopic removal of OTSC or FTRD clips (Ovesco Endoscopy AG, Tuebingen, Germany). The aim of this paper is to assess the efficacy and safety of this system. MATERIAL AND METHODS A total of 74 patients underwent clip extraction. The standard removal procedure comprises fragmenting the clip by applying an electrical direct current pulse at two opposing sides of the clip. RESULTS Clip fragmentation was successful in 72 of 74 patients (97.3%). In two cases (2.7%) clip fragmentation was not possible. In nine cases (12.2%) a clip fragment could not be removed and was left in place. Complications occurred in three cases (4.1%): two minor bleedings near the clip removal site (2.7%), and one superficial mucosal tear resulting from clip fragment extraction (1.4%). DISCUSSION Based on this study, the use of the remOVE System for OTSC or FTRD clip removal can be considered safe and effective.
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Affiliation(s)
| | - Arthur Schmidt
- b Department of Gastroenterology and Oncology , Klinikum Ludwigsburg , Ludwigsburg , Germany
| | - Karel Caca
- b Department of Gastroenterology and Oncology , Klinikum Ludwigsburg , Ludwigsburg , Germany
| | - Peter Bauerfeind
- c Department of Gastroenterology and Hepatology , University Hospital , Zurich , Switzerland
| | | | | | - Thomas Gottwald
- a Ovesco Endoscopy AG , Tuebingen , Germany.,d Medical Faculty , University of Tuebingen , Germany
| | - Marc O Schurr
- a Ovesco Endoscopy AG , Tuebingen , Germany.,e IHCI-Institute , Steinbeis University Berlin , Tuebingen , Germany
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Khater S, Rahmi G, Perrod G, Samaha E, Benosman H, Abbes L, Malamut G, Cellier C. Over-the-scope clip (OTSC) reduces surgery rate in the management of iatrogenic gastrointestinal perforations. Endosc Int Open 2017; 5:E389-E394. [PMID: 28508033 PMCID: PMC5429170 DOI: 10.1055/s-0043-104862] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background and study aims Over-the-scope clip (OTSC) has been recently used in management of gastrointestinal perforations, but data on it are still limited. The aim of this study was to compare management of iatrogenic perforations before and after the OTSC was available in our endoscopy unit. Patients and methods We conducted a monocentric retrospective study from June 2007 to June 2015. All iatrogenic gastrointestinal perforations detected during endoscopy were included. Two time periods were compared in terms of surgery and mortality rates: before use of OTSC (June 2007 to June 2011) and after OTSC became available (June 2011 to June 2015). Results During the first period, 24 perforations were recorded. Fifteen (62.5 %) were managed with surgery. The mortality rate was 8 %. During the second period, 16 perforations occurred. In 11 patients (68.7 %), an OTSC was used to close the perforation, with complete sealing of the perforation in 100 % of cases. However, 2 patients with sigmoid perforation had to undergo surgery due to right ureteral obstruction by the clip in 1 case and to presence of a localized peritonitis in the other. The surgery rate during this period was 12.5 % (2 /16), with a statistically significant difference compared to the first period (P = 0.002). There was no mortality in the second period versus 8 % in the first one (P = 0.23). Conclusions OTSC is effective for endoluminal closure of iatrogenic perforations and results in a significant decrease in surgery rate.
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Affiliation(s)
- Sherine Khater
- Department of Gastroenterology and Digestive Endoscopy, Georges Pompidou European Hospital, Assistance Publique – Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, Paris, France,Corresponding author Sherine Khater, MD Department of Gastroenterology and Digestive EndoscopyGeorges Pompidou European Hospital20 rue Leblanc75015 ParisFrance+33-1-56-09-29-14
| | - Gabriel Rahmi
- Department of Gastroenterology and Digestive Endoscopy, Georges Pompidou European Hospital, Assistance Publique – Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Guillaume Perrod
- Department of Gastroenterology and Digestive Endoscopy, Georges Pompidou European Hospital, Assistance Publique – Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Elia Samaha
- Department of Gastroenterology and Digestive Endoscopy, Georges Pompidou European Hospital, Assistance Publique – Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Hedi Benosman
- Department of Gastroenterology and Digestive Endoscopy, Georges Pompidou European Hospital, Assistance Publique – Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Leila Abbes
- Department of Gastroenterology and Digestive Endoscopy, Georges Pompidou European Hospital, Assistance Publique – Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Georgia Malamut
- Department of Gastroenterology and Digestive Endoscopy, Georges Pompidou European Hospital, Assistance Publique – Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Christophe Cellier
- Department of Gastroenterology and Digestive Endoscopy, Georges Pompidou European Hospital, Assistance Publique – Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
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Bauder M, Meier B, Caca K, Schmidt A. Endoscopic removal of over-the-scope clips: Clinical experience with a bipolar cutting device. United European Gastroenterol J 2016; 5:479-484. [PMID: 28588877 DOI: 10.1177/2050640616671846] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 09/05/2016] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Over-the-scope clips (OTSCs) are increasingly used for the closure of perforations/fistulae, hemostasis and endoscopic full-thickness resection (FTRD system). When OTSC-associated complications occur or re-therapy at the OTSC site is needed, OTSC removal may be indicated. An experimental study in an animal model and a case series have shown good results for OTSC removal with a bipolar cutting device. We present a larger clinical study using this device. METHODS Data of all consecutive patients with indication for OTSC removal were collected and analyzed retrospectively. OTSCs were cut at two opposing sites using a bipolar grasping device to apply short direct current impulses. OTSC fragments were extracted with a standard forceps and a cap at the tip of the endoscope to avoid tissue damage. RESULTS Between December 2012 and February 2016 a total of 42 OTSC removals in the upper (n = 25) and lower (n = 17) gastrointestinal tract have been performed at our department. Overall technical success, defined as cutting the OTSC at two opposing sites and extraction of both fragments, was achieved in 92.9% (39/42) of all cases. Successful fragmentation of the OTSC was achieved in 97.6% (41/42). Minor bleedings were rare and could be managed endoscopically in all cases. There were no perforations and no major or delayed bleedings. CONCLUSION Endoscopic OTSC removal with a bipolar cutting device is feasible, effective and safe. This technique can be applied in the upper and lower gastrointestinal tract.
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Affiliation(s)
- Markus Bauder
- Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Benjamin Meier
- Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Karel Caca
- Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Arthur Schmidt
- Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany
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Wedi E, Gonzalez S, Menke D, Kruse E, Matthes K, Hochberger J. One hundred and one over-the-scope-clip applications for severe gastrointestinal bleeding, leaks and fistulas. World J Gastroenterol 2016; 22:1844-1853. [PMID: 26855543 PMCID: PMC4724615 DOI: 10.3748/wjg.v22.i5.1844] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 09/27/2015] [Accepted: 12/01/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the efficacy and clinical outcome of patients treated with an over-the-scope-clip (OTSC) system for severe gastrointestinal hemorrhage, perforations and fistulas.
METHODS: From 02-2009 to 10-2012, 84 patients were treated with 101 OTSC clips. 41 patients (48.8%) presented with severe upper-gastrointestinal (GI) bleeding, 3 (3.6%) patients with lower-GI bleeding, 7 patients (8.3%) underwent perforation closure, 18 patients (21.4%) had prevention of secondary perforation, 12 patients (14.3%) had control of secondary bleeding after endoscopic mucosal resection or endoscopic submucosal dissection (ESD) and 3 patients (3.6%) had an intervention on a chronic fistula.
RESULTS: In 78/84 patients (92.8%), primary treatment with the OTSC was technically successful. Clinical primary success was achieved in 75/84 patients (89.28%). The overall mortality in the study patients was 11/84 (13.1%) and was seen in patients with life threatning upper GI hemorrhage. There was no mortality in any other treatment group. In detail OTSC application lead to a clinical success in 35/41 (85.36%) patients with upper GI bleeding and in 3/3 patients with lower GI bleeding. Technical success of perforation closure was 100% while clinical success was seen in 4/7 cases (57.14%) due to attendant circumstances unrelated to the OTSC. Technical and clinic success was achieved in 18/18 (100%) patients for the prevention of bleeding or perforation after endoscopic mucosal resection and ESD and in 3/3 cases of fistula closure. Two application-related complications were seen (2%).
CONCLUSION: This largest single center experience published so far confirms the value of the OTSC for GI emergencies and complications. Further clinical experience will help to identify optimal indications for its targeted and prophylactic use.
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Ghassemi KA, Jensen DM. Evolving techniques for gastrointestinal endoscopic hemostasis treatment. Expert Rev Gastroenterol Hepatol 2016; 10:615-23. [PMID: 26651414 PMCID: PMC6063521 DOI: 10.1586/17474124.2016.1130623] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
With mortality due to gastrointestinal (GI) bleeding remaining stable, the focus on endoscopic hemostasis has been on improving other outcomes such as rebleeding rate, need for transfusions, and need for angiographic embolization or surgery. Over the past few years, a number of devices have emerged to help endoscopically assess and treat bleeding GI lesions. These include the Doppler endoscopic probe, hemostatic powder, and over-the-scope clip. Also, new applications have been described for radiofrequency ablation. In this article, we will discuss these evolving tools and techniques that have been developed, including an analysis of their efficacy and limitations.
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Affiliation(s)
- Kevin A. Ghassemi
- Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA,CURE Hemostasis Research Group
| | - Dennis M. Jensen
- Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA,CURE Hemostasis Research Group,Division of Gastroenterology, VA Greater Los Angeles Healthcare Center, Los Angeles, CA, USA
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Schostek S, Ho CN, Melbert M, Krautwald M, Caputo A, Parisi G, Wehrmann M, Gottwald T, Schurr MO. DC current pulses for OTSC clip fragmentation: technology and experimental study. Surg Endosc 2014; 29:2418-22. [DOI: 10.1007/s00464-014-3935-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 10/02/2014] [Indexed: 02/07/2023]
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14
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Mönkemüller K, Peter S, Toshniwal J, Popa D, Zabielski M, Stahl RD, Ramesh J, Wilcox CM. Multipurpose use of the 'bear claw' (over-the-scope-clip system) to treat endoluminal gastrointestinal disorders. Dig Endosc 2014; 26:350-7. [PMID: 23855514 DOI: 10.1111/den.12145] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 06/13/2013] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIM The 'bear-claw' or over-the-scope-clip system (OTSC; Ovesco Endoscopy, Tübingen, Germany) is a new clipping device developed for closure of large luminal gastrointestinal (GI) defects. The aim of the present study was to evaluate the clinical outcomes of patients treated with the OTSC. METHODS The present study was an observational, open-label, retrospective, single-arm case series conducted at two hospitals with tertiary care endoscopy. It involved 20 clip applications in 16 patients (median age 65.8 years [range 51-90 years], seven women) with GI defects from fistulas and anastomotic dehiscence and peptic ulcer bleeding. RESULTS The range of indications included gastrointestinal bleeding (n=6), gastrocutaneous fistulas (n=3), esophagotracheal and/or esophagopleural fistulae (n=3), resection ofsubmucosal tumor (n=2), stent fixation (n=1), and anastomotic leak after esophagectomy (n=1). The overall success rate for the OTSC device was 75% (12 out of 16 patients). The overall per case success rate was 70% (14 of 20 applications). Mean follow up was 10 months (range 1-10). There were no complications (0%) related to endoscopy, sedation or application of the clipping device. CONCLUSIONS The OTSC system is a useful device in a variety of clinical scenarios including the management of larger GI leaks and fistulas, GI bleeding, full-thickness resection of tumors, and stent anchoring, even in very old and frail patients.
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Affiliation(s)
- Klaus Mönkemüller
- Division of Gastroenterology and Hepatology, Basil Hirschowitz Endoscopic Center of Excellence; Department of Internal Medicine, Gastroenterology and Infectious Diseases, Marienhospital, Bottrop, Germany
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Current innovations in endoscopic therapy for the management of colorectal cancer: from endoscopic submucosal dissection to endoscopic full-thickness resection. BIOMED RESEARCH INTERNATIONAL 2014; 2014:925058. [PMID: 24877148 PMCID: PMC4022075 DOI: 10.1155/2014/925058] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 04/11/2014] [Accepted: 04/14/2014] [Indexed: 12/11/2022]
Abstract
Endoscopic submucosal dissection (ESD) is accepted as a minimally invasive treatment for colorectal cancer. However, due to technical difficulties and an increased rate of complications, ESD is not widely used in the colorectum. In some cases, endoscopic treatment alone is insufficient for disease control, and laparoscopic surgery is required. The combination of laparoscopic surgery and endoscopic resection represents a new frontier in cancer treatment. Recent developments in advanced polypectomy and minimally invasive surgical techniques will enable surgeons and endoscopists to challenge current practice in colorectal cancer treatment. Endoscopic full-thickness resection (EFTR) of the colon offers the potential to decrease the postoperative morbidity and mortality associated with segmental colectomy while enhancing the diagnostic yield compared to current endoscopic techniques. However, closure is necessary after EFTR and natural transluminal endoscopic surgery (NOTES). Innovative methods and new devices for EFTR and suturing are being developed and may potentially change traditional paradigms to achieve minimally invasive surgery for colorectal cancer. The present paper aims to discuss the complementary role of ESD and the future development of EFTR. We focus on the possibility of achieving EFTR using the ESD method and closing devices.
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Abstract
Gastrointestinal endoscopy is a rapidly evolving field. Techniques in endoscopy continue to become more sophisticated, as do the devices and platforms, particularly in colonoscopy and endoscopic resection. This article reviews new platforms for endoscopic imaging of the colon, and discusses new endoscopic accessories and developments in endoscopic resection.
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Arezzo A, Bullano A, Fischer H, Morino M. The way to remove an over-the-scope-clip (with video). Gastrointest Endosc 2013; 77:974-5. [PMID: 23684096 DOI: 10.1016/j.gie.2013.01.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 01/24/2013] [Indexed: 12/11/2022]
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Neumann H, Wildner D, Tontini GE, Grauer M, Neurath MF, Mönkemüller K. Response. Gastrointest Endosc 2013; 77:975-6. [PMID: 23684097 DOI: 10.1016/j.gie.2013.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 02/04/2013] [Indexed: 12/11/2022]
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