title: Endoscopic closure of postoperative gastrointestinal leakages and fistulas with the Over-the-Scope Clip (OTSC).
abstract: BACKGROUND
  In contrast to conventional Through-the-Scope Clips, the novel Over-the-Scope Clip (OTSC(®)) allows endoscopic full thickness closure of gastrointestinal leakages. The purpose of this study was to evaluate the efficacy and safety of the OTSC for the management of postoperative gastrointestinal leakages and fistulas.
  
  
  METHODS
  We retrospectively reviewed a series of 14 consecutive patients with postoperative gastrointestinal leakages and fistulas who were treated by OTSC application.
  
  
  RESULTS
  Nine OTSCs were used for upper GI tract leakages; five were used for colorectal leakages. Seventy-nine percent (11/14) of leakages were chronic (treated by OTSC later than postoperative day 14). In nine patients, other therapies preceded OTSC application. Median follow-up time was 5.5 months (range, 0.25-17). Primary technical success was achieved in all (14/14) patients. No adverse events related to the use of the OTSC device were noted. Three early recurrences were observed (two colonic fistulas, one esophageal anastomotic leakage), leading to a long-term success rate of 79 % (11/14). Leakage closure finally was achieved in these three patients by surgery or endoscopic vacuum therapy.
  
  
  CONCLUSIONS
  The OTSC system is an effective and safe method for the management of postoperative leakages and fistulas of the gastrointestinal tract. Its exact place in treatment algorithms of postoperative leakages will have to be determined.
authors: Department of General and Visceral Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany. rudolf.mennigen@ukmuenster.de
authors: Rudolf
authors: R
authors: Mennigen
authors: Mario
authors: M
authors: Colombo-Benkmann
authors: Norbert
authors: N
authors: Senninger
authors: Mike
authors: M
authors: Laukoetter
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak / Q000209:etiology / Q000601:surgery*; D001983:Bronchial Fistula / Q000601:surgery; D003108:Colonic Diseases / Q000601:surgery; D017577:Cutaneous Fistula / Q000601:surgery; D016154:Digestive System Fistula / Q000601:surgery; D016099:Endoscopy, Gastrointestinal / Q000295:instrumentation*; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005402:Fistula / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010995:Pleural Diseases / Q000601:surgery; D012008:Recurrence; D012189:Retrospective Studies; D013272:Stomach Diseases / Q000601:surgery
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