title: International multicenter experience with an over-the-scope clipping device for endoscopic management of GI defects (with video).
abstract: BACKGROUND
  The over-the-scope clip (OTSC) provides more durable and full-thickness closure as compared with standard clips. Only case reports and small case series have reported on outcomes of OTSC closure of GI defects.
  
  
  OBJECTIVE
  To describe a large, multicenter experience with OTSCs for the management of GI defects. Secondary goals were to determine success rate by type of defect and type of therapy and to determine predictors of treatment outcomes.
  
  
  METHODS
  Multicenter, retrospective study.
  
  
  METHODS
  Multiple, international, academic centers.
  
  
  METHODS
  Consecutive patients who underwent attempted OTSC placement for GI defects, either as a primary or as a rescue therapy.
  
  
  METHODS
  OTSC placement to attempt closure of GI defects.
  
  
  METHODS
  Long-term success of the procedure.
  
  
  RESULTS
  A total of 188 patients (108 fistulae, 48 perforations, 32 leaks) were included. Long-term success was achieved in 60.2% of patients during a median follow-up of 146 days. Rate of successful closure of perforations (90%) and leaks (73.3%) was significantly higher than that of fistulae (42.9%) (P < .05). Long-term success was significantly higher when OTSCs were applied as primary therapy (primary 69.1% vs rescue 46.9%; P = .004). On multivariate analysis, patients who had OTSC placement for perforations and leaks had significantly higher long-term success compared with those who had fistulae (OR 51.4 and 8.36, respectively).
  
  
  CONCLUSIONS
  Retrospective design and multiple operators with variable expertise with the OTSC device.
  
  
  CONCLUSIONS
  OTSC is safe and effective therapy for closure of GI defects. Clinical success is best achieved in patients undergoing closure of perforations or leaks when OTSC is used for primary or rescue therapy. Type of defect is the best predictor of successful long-term closure.
authors.affiliation: Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Yamile
authors.initials: Y
authors.lastname: Haito-Chavez
authors.affiliation: Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Joanna K
authors.initials: JK
authors.lastname: Law
authors.affiliation: Department of General, Visceral and Transplant Surgery, University Hospital of Tübingen, Tübingen, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kratt
authors.affiliation: Department of Surgical Sciences, University of Torino, Torino, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Arezzo
authors.affiliation: Department of Surgical Sciences, University of Torino, Torino, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Verra
authors.affiliation: Department of Surgical Sciences, University of Torino, Torino, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Morino
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA.
authors.forename: Reem Z
authors.initials: RZ
authors.lastname: Sharaiha
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
authors.forename: Jan-Werner
authors.initials: JW
authors.lastname: Poley
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA.
authors.forename: Michel
authors.initials: M
authors.lastname: Kahaleh
authors.affiliation: Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Thompson
authors.affiliation: Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Michele B
authors.initials: MB
authors.lastname: Ryan
authors.affiliation: Division of Gastroenterology, University of Michigan Medical Center, Ann Arbor, Michigan, USA.
authors.forename: Neel
authors.initials: N
authors.lastname: Choksi
authors.affiliation: Division of Gastroenterology, University of Michigan Medical Center, Ann Arbor, Michigan, USA.
authors.forename: B Joseph
authors.initials: BJ
authors.lastname: Elmunzer
authors.affiliation: Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Sonia
authors.initials: S
authors.lastname: Gosain
authors.affiliation: Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Goldberg
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Winthrop University Hospital, Mineola, New York, USA.
authors.forename: Rani J
authors.initials: RJ
authors.lastname: Modayil
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Winthrop University Hospital, Mineola, New York, USA.
authors.forename: Stavros N
authors.initials: SN
authors.lastname: Stavropoulos
authors.affiliation: Swedish Gastroenterology, Swedish Medical Center, Seattle, Washington, USA.
authors.forename: Drew B
authors.initials: DB
authors.lastname: Schembre
authors.affiliation: Division of Gastroenterology, The Mount Sinai Medical Center, New York, New York, USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: DiMaio
authors.affiliation: Gastroenterology Division, Department of Internal Medicine, University of Pennsylvania Health System, Philadelphia, PA, USA.
authors.forename: Vinay
authors.initials: V
authors.lastname: Chandrasekhara
authors.affiliation: Center for Interventional Endoscopy, Florida Hospital, Orlando, Florida, USA.
authors.forename: Muhammad K
authors.initials: MK
authors.lastname: Hasan
authors.affiliation: Center for Interventional Endoscopy, Florida Hospital, Orlando, Florida, USA.
authors.forename: Shyam
authors.initials: S
authors.lastname: Varadarajulu
authors.affiliation: Center for Interventional Endoscopy, Florida Hospital, Orlando, Florida, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Hawes
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Jacksonville, Florida, USA.
authors.forename: Victoria
authors.initials: V
authors.lastname: Gomez
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Jacksonville, Florida, USA.
authors.forename: Timothy A
authors.initials: TA
authors.lastname: Woodward
authors.affiliation: Department of Gastroenterology, Clinica Las Condes, Universidad de Chile, Santiago, Chile.
authors.forename: Sergio
authors.initials: S
authors.lastname: Rubel-Cohen
authors.affiliation: Department of Gastroenterology, Clinica Las Condes, Universidad de Chile, Santiago, Chile.
authors.forename: Fernando
authors.initials: F
authors.lastname: Fluxa
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Frank P
authors.initials: FP
authors.lastname: Vleggaar
authors.affiliation: Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Venkata S
authors.initials: VS
authors.lastname: Akshintala
authors.affiliation: Department of Gastroenterology, Hepatology, and Nutrition, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Gottumukkala S
authors.initials: GS
authors.lastname: Raju
authors.affiliation: Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Mouen A
authors.initials: MA
authors.lastname: Khashab
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000175:diagnosis / Q000601:surgery; D015331:Cohort Studies; D016154:Digestive System Fistula / Q000175:diagnosis / Q000601:surgery; D016099:Endoscopy, Gastrointestinal / Q000295:instrumentation* / Q000379:methods; D004867:Equipment Design; D004869:Equipment Safety; D005260:Female; D005500:Follow-Up Studies; D005767:Gastrointestinal Diseases / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D007391:International Cooperation; D007416:Intestinal Perforation / Q000175:diagnosis / Q000601:surgery; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D013525:Surgical Instruments; D013536:Suture Techniques / Q000295:instrumentation*; D013718:Tensile Strength; D016896:Treatment Outcome; D014741:Video Recording