OTSC® closure of the entry site in POEM and G-POEM procedures is related to less clip-related adverse events when compared to closure with conventional clips

In 46 POEM and 26 G-POEM procedures, OTSC closure of the entry site was related to 13 % and 0 % clip-related adverse events, whereas closure with conventional clips led to 21.7 % and 7.7 % clip-related adverse events. Only a single OTSC clip was used in all procedures compared to 5 and 6 conventional clips in POEM and G-POEM procedures, respectively.

Ó.V. Hernández Mondragón et al., Endoscopy Department, National Medical Center Century XXI, Mexico City, Mexico, published a study comparing OTSC and conventional clips for entry site closure in per-oral endoscopy myotomy (POEM) and gastric peroral endoscopy myotomy (G-POEM) procedures.

46 POEM and 26 G-POEM procedures were included in the study. In the POEM group, 23 patients received entry site closure (ESC) with OTSC and in the remaining 23 patients ESC was performed with conventional clips (CC). In the G-POEM group, ESC closure was performed in 13 patients with OTSC and in 13 with CCs.

In POEM procedures, no differences were found between the OTSC and CC arm regarding demographic data and pre-interventional clinical characteristics. Besides, there were no differences between the OTSC and the CC arm regarding tunnel length, myotomy length, incision size and procedure time. However, in the CC arm compared with the OTSC arm, there were longer clip placement times (6.5 ± 1.1 vs 3.2 ± 0.7 minutes; p = 0.01), higher number of clips used (5 vs 1; p = 0.01) and more clip related adverse events (21.7 % vs 13 %; p = 0.01). Clinical POEM success was 100 % for both arms.

In G-POEM procedures no demographic or pre-interventional clinical differences were found between the OTSC and the CC arm. Also procedural characteristics were similar. However, longer clip placement times (6.9 ± 1.4 vs 3.1 ± 1.1; p = 0.02), a higher number of clips used (6 vs 1; p = 0.01) and more clip related adverse events (7.7 % vs 0 %; p = 0.02) were reported in the CC arm compared with OTSC group. G-POEM had a 100 % clinical efficacy for both arms.

The authors concluded that OTSC represents a safe and effective alternative for entry site closure in POEM and G-POEM procedures. Further studies are needed to recommend OTSC as the first option for submucosal tunnel closure in these cases.

Conventional clips vs over-the-scope-clips for the closure of the entry site in POEM and G-POEM procedures
Hernández Mondragón ÓV, Gutiérrez-Aguilar R, García Contreras LF, Palos-Cuéllar R, Blanco Velasco G, Monroy Teniza ZA
Rev Esp Enferm Dig. 2020; 112 (5): 338-342.