title: One hundred and one over-the-scope-clip applications for severe gastrointestinal bleeding, leaks and fistulas.
abstract: OBJECTIVE
  To investigate the efficacy and clinical outcome of patients treated with an over-the-scope-clip (OTSC) system for severe gastrointestinal hemorrhage, perforations and fistulas.
  
  
  METHODS
  From 02-2009 to 10-2012, 84 patients were treated with 101 OTSC clips. 41 patients (48.8%) presented with severe upper-gastrointestinal (GI) bleeding, 3 (3.6%) patients with lower-GI bleeding, 7 patients (8.3%) underwent perforation closure, 18 patients (21.4%) had prevention of secondary perforation, 12 patients (14.3%) had control of secondary bleeding after endoscopic mucosal resection or endoscopic submucosal dissection (ESD) and 3 patients (3.6%) had an intervention on a chronic fistula.
  
  
  RESULTS
  In 78/84 patients (92.8%), primary treatment with the OTSC was technically successful. Clinical primary success was achieved in 75/84 patients (89.28%). The overall mortality in the study patients was 11/84 (13.1%) and was seen in patients with life-threatening upper GI hemorrhage. There was no mortality in any other treatment group. In detail OTSC application lead to a clinical success in 35/41 (85.36%) patients with upper GI bleeding and in 3/3 patients with lower GI bleeding. Technical success of perforation closure was 100% while clinical success was seen in 4/7 cases (57.14%) due to attendant circumstances unrelated to the OTSC. Technical and clinic success was achieved in 18/18 (100%) patients for the prevention of bleeding or perforation after endoscopic mucosal resection and ESD and in 3/3 cases of fistula closure. Two application-related complications were seen (2%).
  
  
  CONCLUSIONS
  This largest single center experience published so far confirms the value of the OTSC for GI emergencies and complications. Further clinical experience will help to identify optimal indications for its targeted and prophylactic use.
authors: Edris Wedi, Juergen Hochberger, Department of Gastroenterology, Nouvel Hôpital Civil and IHU, Strasbourg University Hospitals, F-67091 Strasbourg, France.
authors: Edris
authors: E
authors: Wedi
authors: Edris Wedi, Juergen Hochberger, Department of Gastroenterology, Nouvel Hôpital Civil and IHU, Strasbourg University Hospitals, F-67091 Strasbourg, France.
authors: Susana
authors: S
authors: Gonzalez
authors: Edris Wedi, Juergen Hochberger, Department of Gastroenterology, Nouvel Hôpital Civil and IHU, Strasbourg University Hospitals, F-67091 Strasbourg, France.
authors: Detlev
authors: D
authors: Menke
authors: Edris Wedi, Juergen Hochberger, Department of Gastroenterology, Nouvel Hôpital Civil and IHU, Strasbourg University Hospitals, F-67091 Strasbourg, France.
authors: Elena
authors: E
authors: Kruse
authors: Edris Wedi, Juergen Hochberger, Department of Gastroenterology, Nouvel Hôpital Civil and IHU, Strasbourg University Hospitals, F-67091 Strasbourg, France.
authors: Kai
authors: K
authors: Matthes
authors: Edris Wedi, Juergen Hochberger, Department of Gastroenterology, Nouvel Hôpital Civil and IHU, Strasbourg University Hospitals, F-67091 Strasbourg, France.
authors: Juergen
authors: J
authors: Hochberger
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D020776:Endoscopes, Gastrointestinal; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D004867:Equipment Design; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D016558:Hemostasis, Endoscopic / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D006801:Humans; D007412:Intestinal Fistula / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D007416:Intestinal Perforation / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013525:Surgical Instruments; D016896:Treatment Outcome; D055815:Young Adult
keywords: Endoscopic therapy; Fistula; Gastrointestinal bleeding; Over-the-scope-clip; Perforation