Over-the-scope clip application yields a high rate of closure in gastrointestinal perforations and may reduce emergency surgery.
BACKGROUND
Perforation of the gastrointestinal tract may cause various complications and may require emergency surgery, even in patients with significant comorbidities.


METHODS
Seventeen consecutive patients with indication for surgery due to a visible gastrointestinal perforation were treated with OTSC application. In this study, cause of perforation, estimated size, location, rate of perforation closure, outcome and complications were reported.


RESULTS
In 11 of 17 patients (64.7 %), OTSC application resulted in permanent closure of perforations, thus avoiding surgery. All 11 successful cases had smaller perforation lengths (5.5 ± 1.9 mm, p < 0.02), widths (3.7 ± 0.9 mm) or area (21.1 ± 9.1 mm(2)), had vital margins of perforations and 1.1 ± 0.3 OTSC per patient were necessary. The six unsuccessful cases (35.3 %) showed larger perforation lengths (13.4 ± 8.8 mm, p < 0.02), widths (5 ± 4.5 mm) and area (97.6 ± 149 mm(2)), had necrotic or soft inflammatory margins and significantly more OTSC (2.3 ± 0.5, p = 0.018) were tried.


CONCLUSIONS
OTSC application yields a high rate of endoscopic perforation closure in patients with macroscopic gastrointestinal perforation, even in an emergency setting, representing an alternative to surgery, especially when the size of the lesion is not too large and when vital or solid perforation margins are expected.
Department of Medicine I, Gastroenterology, University of Erlangen-Nuremberg, Ulmenweg 18, 91054 Erlangen, Germany. alexander.hagel@uk-erlangen.de
Alexander Fritzkarl
AF
Hagel
Andreas
A
Naegel
Annette Simone
AS
Lindner
Hermann
H
Kessler
Klaus
K
Matzel
Wolfgang
W
Dauth
Markus Friedrich
MF
Neurath
Martin
M
Raithel
D000368:Aged; D000369:Aged, 80 and over; D004638:Emergency Treatment; D004724:Endoscopy; D016099:Endoscopy, Gastrointestinal / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D005774:Gastrostomy; D006801:Humans; D007049:Iatrogenic Disease; D007416:Intestinal Perforation / Q000473:pathology / Q000601:surgery*; D008297:Male