66.6 % of patients with leaking from the “J” of the tip of an ileo-anal pouch anastomosis were spared surgery by use of the OTSC®
The tip of the “J” ileal pouch is the vulnerable location for leak after restorative proctocolectomy, which has normally been treated with surgery.
Lian L and Shen B, Interventional IBD Center, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA, described the first case of endoscopic treatment of the leak at the tip of the “J” with OTSC in 2014. Since then, OTSC therapy has become the first-line approach for this lesion in the Cleveland Clinic.
Recently, Kochhar GS and Shen B, same affiliation, published a cohort study comprising 12 consecutive patients with a leak at the tip of the “J” from the Center’s prospectively maintained Pouch Registry. In all patients, OTSC was used for leak closure.
All 12 patients had successful deployment of OTSC during endoscopy. No excessive bleeding or perforation was observed. Eight patients (66.6 %) achieved complete closure of the leak documented by endoscopy confirmed with guidewire and/or contrasted pouchogram, with 6 requiring a single endoscopic session and 2 undergoing a repeat session. Four patients (33.3 %) had a persistent leak and required surgical intervention, of whom 1 developed abscess in the pre-spine region 14 days after the endoscopic procedure and underwent pouch revision surgery.
The authors concluded that leaking from the tip of the “J” in patients with ileo-anal pouch anastomosis can be effectively and safely treated with the over-the-scope clipping system.
Endoscopic treatment of leak at the tip of the “J” ileal pouch
Kochhar GS, Shen B (2017)
Endoscopy International Open 2017; 05: E64-E66