title: Role of endoscopic clipping in the treatment of oesophageal perforations.
abstract: With advances in endoscopic technologies, endoscopic clips have been used widely and successfully in the treatment of various types of oesophageal perforations, anastomosis leakages and fistulas. Our aim was to summarize the experience with two types of clips: The through-the-scope (TTS) clip and the over-the-scope clip (OTSC). We summarized the results of oesophageal perforation closure with endoscopic clips. We processed the data from 38 articles and 127 patients using PubMed search. Based on evidence thus far, it can be stated that both clips can be used in the treatment of early (< 24 h), iatrogenic, spontaneous oesophageal perforations in the case of limited injury or contamination. TTS clips are efficacious in the treatment of 10 mm lesions, while bigger (< 20 mm) lesions can be treated successfully with OTSC clips, whose effectiveness is similar to that of surgical treatment. However, the clinical success rate is significantly lower in the case of fistulas and in the treatment of anastomosis insufficiency. Tough prospective randomized multicentre trials, which produce the largest amount of evidence, are still missing. Based on experience so far, endoscopic clips represent a possible therapeutic alternative to surgery in the treatment of oesophageal perforations under well-defined conditions.
authors.affiliation: György Lázár, Attila Paszt, Eszter Mán, Department of Surgery, University of Szeged, Szeged 6720, Hungary.
authors.forename: György
authors.initials: G
authors.lastname: Lázár
authors.affiliation: György Lázár, Attila Paszt, Eszter Mán, Department of Surgery, University of Szeged, Szeged 6720, Hungary.
authors.forename: Attila
authors.initials: A
authors.lastname: Paszt
authors.affiliation: György Lázár, Attila Paszt, Eszter Mán, Department of Surgery, University of Szeged, Szeged 6720, Hungary.
authors.forename: Eszter
authors.initials: E
authors.lastname: Mán
keywords: Endoscopic clipping; Endoscopy; Oesophageal perforation; Over-the-scope clip; Upper gastrointestinal perforation