Raithel M and colleagues, Department of Medicine II, University Erlangen, Germany presented data from three tertiary referral centers with 24-h emergency endoscopy (Erlangen, Wuerzburg, Fuerth) on patients receiving OTSC® therapy for acute gastrointestinal wall defects.
Unselected consecutive patients presenting with acute non-surgical perforations, postoperative anastomotic leaks or inadvertent postoperative perforations underwent attempted OTSC® placement as primary closure method after interdisciplinary consensus. Their clinical data and intervention characteristics were evaluated in an intention to treat analysis during a 24-month period to assess closure rates, 30-day mortality, hospitalization and comorbidity.
In total, 34 patients were included with 22 non-surgical perforations and 12 postoperative leaks or perforations. 5 GI defects were located in the oesophagus, 14 in the stomach, 4 in the duodenum, 2 in the jejunum, 1 in the ileum, 2 in the colon, and 6 in the rectum. Definitive closure of the perforations and leaks was achieved in 26 patients (76.5 %). The closure rate among non-surgically caused perforations was 72.7 % and among acute postoperative GI wall defects 83.3 % in total. Successful closure of the GI wall defect resulted in a significantly shorter hospital stay (8 vs 18 days, p = 0.03). In the group with OTSC® failure, 6 of 8 patients (75 %) required immediate surgery. In the group with successful OTSC® closure, comorbidity rate was significantly higher (19/26 patients vs 4/8 patients in the group with OTSC® failure; p = 0.005). Three deaths occurred in the group with successful OTSC® closure due to comorbidity, while one death in the OTSC® failure group was related to a refractory perforation. Favourable indications and locations for a successful OTSC® procedure were identified as PEG complications, and endoscopic or postoperative leaks of stomach, colon or rectum.
The authors concluded, that OTSC® was effective for closure of acute GI wall defects in more than 75 % of patients in an unselected cohort.
Outcome, comorbidity, hospitalization and 30-day mortality after closure of acute perforations and postoperative anastomotic leaks by the over-the-scope clip (OTSC) in an unselected cohort of patients
Raithel M, Albrecht H, Scheppach W, Farnbacher M, Haupt W, Hagel AF, Schellerer V, Vitali F, Neurath MF, Schneider HT (2016)
Surg Endosc 2017 Jun; 31 (6): 2411-2425.