Mizrahi I and colleagues, Digestive Disease Institute, Cleveland Clinic Florida, Weston, FL, USA, reported their institutional experience with OTSC® for patients with GI defects.
Gastrointestinal tract defects are associated with high patient morbidity and pose a clinical and technical challenge for surgeons and gastroenterologists. Defects such as anastomotic leak and fistula are reported in up to 13 % of patients following upper GI tract surgery for weight loss. Even higher rates are reported after colorectal surgery for malignant and inflammatory indications. The conventional treatment of the defects mentioned above is surgery, often including stoma creation or percutaneous drainage with the obvious related morbidity.
For the study, prospective data from all patients treated with OTSC® in the institution were analyzed. Primary outcome was the clinical success of the OTSC® for the individual indication.
During the study period, 51 patients (28 females, mean age 54.9 ± 19.4 years) were treated with OTSC®, 21 patients had defects in the lower GI tract (LGI) and 30 patients in the upper GI tract (UGI). The most common indication for OTSC® was anastomotic leak (n=24; UGI = 12, LGI =12), followed by chronic fistula (n=17; UGI = 8, LGI = 9), acute perforation (n=4), acute bleeding (n=4) and stent anchoring (n=2). OTSC® was the primary therapy in all patients with bleeding and stent anchoring, in all other patients alternative endoscopic or surgical attempts had been made prior to OTSC®.
Technical success was achieved in 98 % of all patients. Clinical success rates for UGI perforation, bleeding, and stent anchoring indications were 75, 75, and 50 %, respectively. Clinical success rate for the treatment of anastomotic leaks was 59 % (UGI 66 % vs LGI 33 %). A lower success rate was noted for chronic fistulae (UGI 62 % vs LGI 0%).
The authors conclude that the OTSC® is a reasonable minimally invasive option for managing patients with various GI defects before a more invasive operative approach is attempted. It appears that the OTSC® is especially valuable in the treatment of acute defects of the upper gastrointestinal tract.
The Clinical Utility of Over-the-Scope Clip for the Treatment of Gastrintestinal Defects
Mizrahi I, Eltawil R, Haim N, Chadi SA, Shen B, Erim T, DaSilva G, Wexner SD (2016)
J Gastrointest Surg 2016; 20: 1942-49