title: Over-the-scope clips in the treatment of gastrointestinal tract iatrogenic perforation: A multicenter retrospective study and a classification of gastrointestinal tract perforations.
abstract: OBJECTIVE
  To determine the outcome of the management of iatrogenic gastrointestinal tract perforations treated by over-the-scope clip (OTSC) placement.
  
  
  METHODS
  We retrospectively enrolled 20 patients (13 female and 7 male; mean age: 70.6 ± 9.8 years) in eight high-volume tertiary referral centers with upper or lower iatrogenic gastrointestinal tract perforation treated by OTSC placement. Gastrointestinal tract perforation could be with oval-shape or with round-shape. Oval-shape perforations were closed by OTSC only by suction and the round-shape by the "twin-grasper" plus suction.
  
  
  RESULTS
  Main perforation diameter was 10.1 ± 4.3 mm (range 3-18 mm). The technical success rate was 100% (20/20 patients) and the clinical success rate was 90% (18/20 patients). Two patients (10%) who did not have complete sealing of the defect underwent surgery. Based upon our observations we propose two types of perforation: Round-shape "type-1 perforation" and oval-shape "type-2 perforation". Eight (40%) out of the 20 patients had a type-1 perforation and 12 patients a type-2 (60%).
  
  
  CONCLUSIONS
  OTSC placement should be attempted after perforation occurring during diagnostic or therapeutic endoscopy. A failed closure attempt does not impair subsequent surgical treatment.
authors.affiliation: Benedetto Mangiavillano, Gastroenterology and Gastrointestinal Endoscopy, Borea Hospital, 18038 Sanremo, Italy.
authors.forename: Benedetto
authors.initials: B
authors.lastname: Mangiavillano
authors.affiliation: Benedetto Mangiavillano, Gastroenterology and Gastrointestinal Endoscopy, Borea Hospital, 18038 Sanremo, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Caruso
authors.affiliation: Benedetto Mangiavillano, Gastroenterology and Gastrointestinal Endoscopy, Borea Hospital, 18038 Sanremo, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Manta
authors.affiliation: Benedetto Mangiavillano, Gastroenterology and Gastrointestinal Endoscopy, Borea Hospital, 18038 Sanremo, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Di Mitri
authors.affiliation: Benedetto Mangiavillano, Gastroenterology and Gastrointestinal Endoscopy, Borea Hospital, 18038 Sanremo, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Arezzo
authors.affiliation: Benedetto Mangiavillano, Gastroenterology and Gastrointestinal Endoscopy, Borea Hospital, 18038 Sanremo, Italy.
authors.forename: Nico
authors.initials: N
authors.lastname: Pagano
authors.affiliation: Benedetto Mangiavillano, Gastroenterology and Gastrointestinal Endoscopy, Borea Hospital, 18038 Sanremo, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Galloro
authors.affiliation: Benedetto Mangiavillano, Gastroenterology and Gastrointestinal Endoscopy, Borea Hospital, 18038 Sanremo, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Mocciaro
authors.affiliation: Benedetto Mangiavillano, Gastroenterology and Gastrointestinal Endoscopy, Borea Hospital, 18038 Sanremo, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Mutignani
authors.affiliation: Benedetto Mangiavillano, Gastroenterology and Gastrointestinal Endoscopy, Borea Hospital, 18038 Sanremo, Italy.
authors.forename: Carmelo
authors.initials: C
authors.lastname: Luigiano
authors.affiliation: Benedetto Mangiavillano, Gastroenterology and Gastrointestinal Endoscopy, Borea Hospital, 18038 Sanremo, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Antonucci
authors.affiliation: Benedetto Mangiavillano, Gastroenterology and Gastrointestinal Endoscopy, Borea Hospital, 18038 Sanremo, Italy.
authors.forename: Rita
authors.initials: R
authors.lastname: Conigliaro
authors.affiliation: Benedetto Mangiavillano, Gastroenterology and Gastrointestinal Endoscopy, Borea Hospital, 18038 Sanremo, Italy.
authors.forename: Enzo
authors.initials: E
authors.lastname: Masci
keywords: Gastrointestinal tract; OVESCO; Over-the-scope clip; Perforation