OTSC® vs surgery in scope-induced duodenal perforations: Retrospective comparison study shows superiority of the OTSC regarding morbidity and mortality

The retrospective analysis included overall 20 patients with type I duodenal perforation. 8 patients were treated with OTSC and 12 by surgery. Baseline parameters and perforation size were similar in both groups. 2 patients in the surgery group died vs none in the OTSC group (p=0.48). Median hospital stay was 2 days in the OTSC group vs. 22 days in the surgery group (p=0.003).

Dahale A. S. et al., Dr. D Y Patil Medical College and Hospital, Pimpri, Pune, India, conducted a study comparing OTSC and surgery in the management of scope-induced duodenal perforations. Retrospectively, data of 20 patients was analyzed. All included perforations had been detected and treated within 24 hours after the endoscopic procedure. Objectives of the study were spectrum, etiology, baseline parameters, perforation size, outcome, comorbidities, and duration of hospital stay. Of the 20 patients, 8 were treated with OTSC placement and 12 underwent surgery. Patient age in both groups was comparable. The majority of patients was female in both groups. Baseline parameters, etiology and comorbidities were similar in both groups. The median size of perforation was 1.5 cm in both, the OTSC and the surgery group.

All patients were treated with standard of care according to institutional protocols. Patients in the OTSC group started oral intake after 48 h of OTSC placement, while in the surgery group median time was 7 days. Median hospital stay was 2 days in the OTSC group vs 22 days in the surgery group (p = 0.003). Intravenous antibiotics were administered for 2 days in the OTSC group followed by oral antibiotics for 2 weeks, while in the surgery group, median duration of intravenous antibiotics was 19.5 days (range 7 – 45 days). There were no complications related to the OTSC. Seven patients from the surgery group had one or more post-surgical complications. Two patients had leak from the wound site and were managed conservatively. Two patients had delirium and spontaneous recovery within 2 days, one of whom also had left lower foot gangrene as thromboembolic phenomenon. One patient had local wound site infection, which was treated with wound care and antibiotics. Two patients in the surgical group died from sepsis und multiorgan failure, while there was no mortality in the OTSC group (p = 0.48).

The authors concluded, that OTSC is a feasible and better option in type I duodenal perforations and associated with a significantly shorter hospital stay, shorter application of intravenous antibiotics, less post-closure complications, earlier start of oral intake and lower mortality rate.

Management of scope-induced type I duodenal perforations: Over-the-scope clip versus surgery
Dahale AS, Srivastava S, Saluja SS, Sachdeva S, Dalal A, Varakanahalli S.
Indian Journal of Gastroenterology (May–June 2021) 40(3):287–294.