"Sparing the surgeon": clinical experience with over-the-scope clips for gastrointestinal perforation.
With increasingly advanced therapeutic endoscopic procedures and more complex gastrointestinal surgery, endoscopists are more often confronted with perforations, fistulas, and anastomotic leakages for which nonsurgical closure is desired. The over-the-scope clip (OTSC) is a novel endoscopic tool for consideration in such situations. We treated seven patients (age range 35 - 83 years; five men, two women), three with colonic perforation, one with perforation of the stomach, and three with anastomotic leakage after gastrointestinal surgery. Follow-up was at least 74 days. Eight OTSCs were deployed. In all but one patient closure of the perforation was demonstrated. Further surgery was avoided in four of the seven patients. The OTSC is a system that is easy to handle and safe. It seems to be ideally suited to use for a relatively small (iatrogenic) perforation, where a single clip can be released with carbon dioxide insufflation. Anastomosis leakage and larger dehiscence can also be treated to avoid further surgery, but the utility in this situation needs to be defined in the future.
Department of Gastroenterology and Hepatology, University Hospital of Zürich, Switzerland.
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L
Seebach
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P
Bauerfeind
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C
Gubler
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000497:Alloys; D057868:Anastomotic Leak / Q000601:surgery*; D003106:Colon / Q000293:injuries / Q000601:surgery; D016099:Endoscopy, Gastrointestinal / Q000295:instrumentation*; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D013525:Surgical Instruments
D000497:Alloys; C013616:nitinol