title: Indication for 'Over the scope' (OTS)-clip vs. covered self-expanding metal stent (cSEMS) is unequal in upper gastrointestinal leakage: results from a retrospective head-to-head comparison.
abstract: BACKGROUND
  Intestinal perforation or leakage increases morbidity and mortality of surgical and endoscopic interventions. We identified criteria for use of full-covered, extractable self-expanding metal stents (cSEMS) vs. 'Over the scope'-clips (OTSC) for leak closure.
  
  
  METHODS
  Patients who underwent endoscopic treatment for postoperative leakage, endoscopic perforation, or spontaneous rupture of the upper gastrointestinal tract between 2006 and 2013 were identified at four tertiary endoscopic centers. Technical success, outcome (e.g. duration of hospitalization, in-hospital mortality), and complications were assessed and analyzed with respect to etiology, size and location of leakage.
  
  
  RESULTS
  Of 106 patients (male: 75 (71%), female: 31 (29%); age (mean ± SD): 62.5 ± 1.3 years, 72 (69%) were treated by cSEMS and 34 (31%) by OTSC. For cSEMS vs. OTSC, mean treatment duration was 41.1 vs. 25 days, p<0.001, leakage size 10 (1-50) vs. 5 (1-30) mm (median (range)), and complications were observed in 68% vs. 8.8%, p<0.001, respectively. Clinical success for primary interventional treatment was observed in 29/72 (40%) vs. 24/34 (70%, p = 0.006), and clinical success at the end of follow-up was 46/72 (64%) vs. 29/34 (85%) for patients treated by cSEMS vs. OTSC; p = 0.04.
  
  
  CONCLUSIONS
  OTSC is preferred in small-sized lesions and in perforation caused by endoscopic interventions, cSEMS in patients with concomitant local infection or abscess. cSEMS is associated with a higher frequency of complications. Therefore, OTSC might be preferred if technically feasible. Indication criteria for cSEMS vs. OTSC vary and might impede design of randomized studies.
authors: Medizinische Klinik 1, Johann Wolfgang Goethe-Universität, Frankfurt, Germany.
authors: Harald
authors: H
authors: Farnik
authors: Medizinische Klinik 1, Johann Wolfgang Goethe-Universität, Frankfurt, Germany.
authors: Marlene
authors: M
authors: Driller
authors: Klinik für Allgemeine, Viszeral- und Transplantationschirurgie, Universitätsklinikum Tübingen, Tübingen, Germany.
authors: Thomas
authors: T
authors: Kratt
authors: Klinik für Innere Medizin IV, Klinikum der Universität Jena, Jena, Germany.
authors: Carsten
authors: C
authors: Schmidt
authors: Medizinische Klinik Mitte Gastroenterologie, Städtisches Klinikum Dortmund, Dortmund, Germany.
authors: Martin
authors: M
authors: Fähndrich
authors: Institut für Biostatistik und mathematische Modellierung, Universitätsklinikum Frankfurt, Frankfurt, Germany.
authors: Natalie
authors: N
authors: Filmann
authors: Klinik für Allgemeine, Viszeral- und Transplantationschirurgie, Universitätsklinikum Tübingen, Tübingen, Germany.
authors: Alfred
authors: A
authors: Königsrainer
authors: Klinik für Innere Medizin IV, Klinikum der Universität Jena, Jena, Germany.
authors: Andreas
authors: A
authors: Stallmach
authors: Medizinische Klinik Mitte Gastroenterologie, Städtisches Klinikum Dortmund, Dortmund, Germany.
authors: Michael
authors: M
authors: Heike
authors: Klinik für Allgemein- und Viszeralchirurgie, Johann Wolfgang Goethe-Universität, Frankfurt, Germany.
authors: Wolf O
authors: WO
authors: Bechstein
authors: Medizinische Klinik 1, Johann Wolfgang Goethe-Universität, Frankfurt, Germany.
authors: Stefan
authors: S
authors: Zeuzem
authors: Medizinische Klinik 1, Johann Wolfgang Goethe-Universität, Frankfurt, Germany.
authors: Jörg G
authors: JG
authors: Albert
mesh_terms: D050110:Bariatric Surgery / Q000009:adverse effects*; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D004867:Equipment Design; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome
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