OTSC and vacuum therapy combined can allow earlier discharge and lead to better outcomes

OTSC® closure after endoscopic vacuum therapy (EVT) has the potential to shorten leakage therapy with significantly lower time to discharge compared to EVT alone

Key findings

• Time interval from leakage detection to discharge was significantly shorter with the combination of OTSC® and EVT with 33 days (range 19-48) compared to EVT alone with 46 days (range 29-77) (p=0.0004)
• Therapy efficacy was 100% in both groups. Additional procedures for leakage management were required in 0% of cases in the OTSC®+EVT group and 12% (n=5) in the EVT group (p=0.021)
• 98% of patients in the OTSC®+EVT group could be discharged on sufficient nutrition compared to 60% in the EVT group (p<0.001)

Study details

• All patients treated with EVT for leakages in the UGI between 2012 and 2022 in a single center were divided into two propensity matched cohorts (OTSC®+EVT vs. EVT only).
• 84 matched patients were analyzed, of which 42 received OTSC®+EVT and 42 EVT alone
• Covariates chosen were gender, age, Charlson comorbidity index, underlying disease, surgical procedure, localization and size of leakage
• In the OTSC®+EVT cohort, OTSC® was applied at the end of the EVT directly after the removal of the last sponge. Prerequisites were: 1) absence of systemic inflammation with successful discontinuation of anti-infective therapy; 2) sufficiently refreshed, vital and epithelialized wound edges of leakage; 3) no more secretion from the defect during endoluminal aspiration with an endoscope; and 4) residual leakage defect < 10 mm

Kollmann L, Weich A, Gruber M, Flemming S, Meining A, Germer C-T, Lock JF, Seyfried F, Brand M, Reimer S. Additional over-the-scope-clip closure can shorten endoscopic vacuum therapy for postoperative upper gastrointestinal leakage. Endosc Int Open. 2024;12(9):E1023-E1028. Doi: 10.1055/a-2387-2054