title: Over-the-scope clip closure for treatment of post-pancreaticogastrostomy pancreatic fistula: A case series.
abstract: OBJECTIVE
  The over-the-scope clip (OTSC) system is a recently developed endoscopic device. In the last few years, it has been successfully used for severe bleeding or deep wall lesions, or perforations of the gastrointestinal (GI) tract. We hereby report a series of patients with post-pancreaticogastrostomy pancreatic fistula in whom OTSC were used as endoscopic treatment.
  
  
  METHODS
  From January 2012 to July 2015, we prospectively collected data on cases of postoperative pancreatic fistula. These patients underwent pancreaticoduodenectomy in a high-volume center of hepatobiliopancreatic surgery. After conservative management, OTSC closure was done by single skilled operators in anesthesiologist-assisted deep sedation.
  
  
  RESULTS
  A total of seven patients were enrolled. According to the International Study Group of Pancreatic Surgery criteria, we observed grade B postoperative pancreatic fistula in all cases. All patients were treated with 12/6 t-type OTSC. In two cases, a second clip was successfully applied to a second site adjacent to the original closure site. In all cases, subsequent fluoroscopy showed no contrastographic spreading through the wall. There were no complications related to the procedure itself, not from the endoscopy point of view, nor from the anesthesiological perspective. There were no device malfunctions. Further clinical and endoscopic evaluation was made 8 weeks later and showed no fistula or anastomotic defect recurrence. No patients required additional endoscopic or interventional procedures.
  
  
  CONCLUSIONS
  In consideration of clinical and technical success, OTSC placement in POPF seems to be effective, safe and technically relatively easy to carry out.
authors.affiliation: Gastroenterology and Digestive Endoscopy Unit, New Civil S. Agostino Estense Hospital, Modena, Italy.
authors.forename: Santi
authors.initials: S
authors.lastname: Mangiafico
authors.affiliation: Gastroenterology and Digestive Endoscopy Unit, New Civil S. Agostino Estense Hospital, Modena, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Caruso
authors.affiliation: Gastroenterology and Digestive Endoscopy Unit, New Civil S. Agostino Estense Hospital, Modena, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Manta
authors.affiliation: Gastroenterology and Digestive Endoscopy Unit, New Civil S. Agostino Estense Hospital, Modena, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Grande
authors.affiliation: Gastroenterology and Digestive Endoscopy Unit, New Civil S. Agostino Estense Hospital, Modena, Italy.
authors.forename: Helga
authors.initials: H
authors.lastname: Bertani
authors.affiliation: Gastroenterology and Digestive Endoscopy Unit, New Civil S. Agostino Estense Hospital, Modena, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Mirante
authors.affiliation: Gastroenterology and Digestive Endoscopy Unit, New Civil S. Agostino Estense Hospital, Modena, Italy.
authors.forename: Flavia
authors.initials: F
authors.lastname: Pigò
authors.affiliation: Plastic and Reconstructive Surgery, Chelsea and Westminster Hospital, London, UK.
authors.forename: Luigi
authors.initials: L
authors.lastname: Magnano
authors.affiliation: Digestive Endoscopy Unit-Northern Area, Ospedale di Carpi, Carpi, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Manno
authors.affiliation: Gastroenterology and Digestive Endoscopy Unit, New Civil S. Agostino Estense Hospital, Modena, Italy.
authors.forename: Rita
authors.initials: R
authors.lastname: Conigliaro
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000601:surgery*; D015331:Cohort Studies; D016099:Endoscopy, Gastrointestinal / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005774:Gastrostomy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D010185:Pancreatic Fistula / Q000209:etiology* / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D016896:Treatment Outcome
keywords: OTSC; endoscopic therapies; pancreaticoduodenectomy; pancreaticogastrostomy; postoperative pancreatic fistula