Download PDF
CC BY-NC-ND 4.0 · Endosc Int Open 2017; 05(05): E389-E394
DOI: 10.1055/s-0043-104862
Original article
Eigentümer und Copyright ©Georg Thieme Verlag KG 2017

Over-the-scope clip (OTSC) reduces surgery rate in the management of iatrogenic gastrointestinal perforations

Sherine Khater
Department of Gastroenterology and Digestive Endoscopy, Georges Pompidou European Hospital, Assistance Publique – Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
,
Gabriel Rahmi
Department of Gastroenterology and Digestive Endoscopy, Georges Pompidou European Hospital, Assistance Publique – Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
,
Guillaume Perrod
Department of Gastroenterology and Digestive Endoscopy, Georges Pompidou European Hospital, Assistance Publique – Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
,
Elia Samaha
Department of Gastroenterology and Digestive Endoscopy, Georges Pompidou European Hospital, Assistance Publique – Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
,
Hedi Benosman
Department of Gastroenterology and Digestive Endoscopy, Georges Pompidou European Hospital, Assistance Publique – Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
,
Leila Abbes
Department of Gastroenterology and Digestive Endoscopy, Georges Pompidou European Hospital, Assistance Publique – Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
,
Georgia Malamut
Department of Gastroenterology and Digestive Endoscopy, Georges Pompidou European Hospital, Assistance Publique – Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
,
Christophe Cellier
Department of Gastroenterology and Digestive Endoscopy, Georges Pompidou European Hospital, Assistance Publique – Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
› Author Affiliations
Further Information

Publication History

submitted 23 September 2016

accepted after revision 01 February 2017

Publication Date:
12 May 2017 (online)

Also available at
   Permissions and Reprints

Abstract

Background and study aims Over-the-scope clip (OTSC) has been recently used in management of gastrointestinal perforations, but data on it are still limited. The aim of this study was to compare management of iatrogenic perforations before and after the OTSC was available in our endoscopy unit.

Patients and methods We conducted a monocentric retrospective study from June 2007 to June 2015. All iatrogenic gastrointestinal perforations detected during endoscopy were included. Two time periods were compared in terms of surgery and mortality rates: before use of OTSC (June 2007 to June 2011) and after OTSC became available (June 2011 to June 2015).

Results During the first period, 24 perforations were recorded. Fifteen (62.5 %) were managed with surgery. The mortality rate was 8 %. During the second period, 16 perforations occurred. In 11 patients (68.7 %), an OTSC was used to close the perforation, with complete sealing of the perforation in 100 % of cases. However, 2 patients with sigmoid perforation had to undergo surgery due to right ureteral obstruction by the clip in 1 case and to presence of a localized peritonitis in the other. The surgery rate during this period was 12.5 % (2 /16), with a statistically significant difference compared to the first period (P = 0.002). There was no mortality in the second period versus 8 % in the first one (P = 0.23).

Conclusions OTSC is effective for endoluminal closure of iatrogenic perforations and results in a significant decrease in surgery rate.

 

  • References

  • 1 Lohsiriwat V. Colonoscopic perforation: Incidence, risk factors, management and outcome. World J Gastroenterol 2010; 16: 425-430
    CrossrefPubMedGoogle Scholar
  • 2 Lüning TH, Keemers-Gels ME, Barendregt WB. et al. Colonoscopic perforations: a review of 30,366 patients. Surg Endosc 2007; 21: 994-997
    CrossrefPubMedGoogle Scholar
  • 3 Ko CW, Dominitz JA. Complications of colonoscopy: magnitude and management. Gastrointest Endosc Clin N Am 2012; 20: 659-671
    PubMedGoogle Scholar
  • 4 ASGE Standards of Practice Committee. Complications of colonoscopy. Gastrointest Endosc 2011; 74: 745-752
    CrossrefPubMedGoogle Scholar
  • 5 Arora G, Mannalithara A, Singh G. et al. Risk of perforation from a colonoscopy in adults: a large population-based study. Gastrointest Endosc 2009; 69: 654-664
    CrossrefPubMedGoogle Scholar
  • 6 ASGE Standards of Practice Committee. Adverse events of upper GI endoscopy. Gastrointest Endosc 2012; 76: 707-718
    CrossrefPubMedGoogle Scholar
  • 7 ASGE Technology Committee, Kantsevoy SV, Adler DG, Conway JD. Endoscopic mucosal resection and endoscopic submucosal dissection. Gastrointest Endosc 2008; 68: 11-18
    CrossrefPubMedGoogle Scholar
  • 8 Taku K, Sano Y, Fu KI. et al. Iatrogenic perforation associated with therapeutic colonoscopy: A multicenter study in Japan. J Gastroenterol Hepatol 2007; 22: 1409-1414
    CrossrefPubMedGoogle Scholar
  • 9 Mangiavillano B, Viaggi P, Masci E. Endoscopic closure of acute iatrogenic perforations during diagnostic and therapeutic endoscopy in the gastrointestinal tract using metallic clips: A literature review. J Dig Dis 2010; 11: 12-18
    CrossrefPubMedGoogle Scholar
  • 10 Kim JS, Kim BW, Kim JI. et al. Endoscopic clip closure versus surgery for the treatment of iatrogenic colon perforations developed during diagnostic colonoscopy: a review of 115,285 patients. Surg Endosc 2013; 27: 501-504
    CrossrefPubMedGoogle Scholar
  • 11 Magdeburg R, Collet P, Post S. et al. Endoclipping of iatrogenic colonic perforation to avoid surgery. Surg Endosc 2008; 22: 1500-1504
    CrossrefPubMedGoogle Scholar
  • 12 Baron TH, Wong Kee Song LM, Zielinski MD. et al. A comprehensive approach to the management of acute endoscopic perforations (with videos). Gastrointest Endosc 2012; 76: 838-859
    CrossrefPubMedGoogle Scholar
  • 13 Voermans RP, van Berge Henegouwen MI, Bemelman WA. et al. Novel over-the-scope-clip system for gastrotomy closure in natural orifice transluminal endoscopic surgery (NOTES): an ex vivo comparison study. Endoscopy 2009; 41: 1052-1055
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 von Renteln D, Schmidt A, Vassiliou MC. et al. Endoscopic closure of large colonic perforations using an over-the-scope clip: a randomized controlled porcine study. Endoscopy 2009; 41: 481-486
    Article in Thieme ConnectPubMedGoogle Scholar
  • 15 Schurr MO, Hartmann C, Ho CN. et al. An over-the-scope clip (OTSC) system for closure of iatrogenic colon perforations: results of an experimental survival study in pigs. Endoscopy 2008; 40: 584-588
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Matthes K, Jung Y, Kato M. et al. Efficacy of full-thickness GI perforation closure with a novel over-the-scope clip application device: an animal study. Gastrointest Endosc 2011; 74: 1369-1375
    CrossrefPubMedGoogle Scholar
  • 17 von Renteln D, Vassiliou MC, Rothstein RI. Randomized controlled trial comparing endoscopic clips and over-the-scope clips for closure of natural orifice transluminal endoscopic surgery gastrotomies. Endoscopy 2009; 41: 1056-1061
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Voermans RP, Le Moine O, von Renteln D. et al. CLIPPER Study Group. Efficacy of endoscopic closure of acute perforations of the gastrointestinal tract. Clin Gastroenterol Hepatol 2012; 10: 603-608
    CrossrefPubMedGoogle Scholar
  • 19 Hagel AF, Naegel A, Lindner AS. et al. Over-the-scope clip application yields a high rate of closure in gastrointestinal perforations and may reduce emergency surgery. J Gastrointest Surg 2012; 16: 2132-2138
    CrossrefPubMedGoogle Scholar
  • 20 Singhal S, Changela K, Papafragkakis H. et al. Over the scope clip: technique and expanding clinical applications. J Clin Gastroenterol 2013; 47: 749-756
    CrossrefPubMedGoogle Scholar
  • 21 Weiland T, Fehlker M, Gottwald T. et al. Performance of the OTSC System in the endoscopic closure of iatrogenic gastrointestinal perforations: a systematic review. Surg Endosc 2013; 27: 2258-2274
    CrossrefPubMedGoogle Scholar
  • 22 Mangiavillano B, Caruso A, Manta R. et al. Over-the-scope clips in the treatment of gastrointestinal tract iatrogenic perforation: A multicenter retrospective study and a classification of gastrointestinal tract perforations. World J Gastrointest Surg 2016; 8: 315-320
    CrossrefPubMedGoogle Scholar
  • 23 Rahmi G, Barret M, Samaha E. et al. Ureteral obstruction after colonoscopic perforation closed with an over-the-scope clip. Gastrointest Endosc 2015; 81: 470-471
    CrossrefPubMedGoogle Scholar
  • 24 Schmidt A, Riecken B, Damm M. et al. Endoscopic removal of over-the-scope clips using a novel cutting device: a retrospective case series. Endoscopy 2014; 46: 762-766
    Article in Thieme ConnectPubMedGoogle Scholar
  • 25 Fähndrich M, Sandmann M, Heike M. Removal of over the scope clips (OTSC) with an Nd:YAG Laser. Z Gastroenterol 2011; 49: 579-583
    Article in Thieme ConnectPubMedGoogle Scholar
  • 26 Schostek S, Ho CN, Melbert M. et al. DC current pulses for OTSC clip fragmentation: technology and experimental study. Surg Endosc 2015; 29: 2418-2422
    CrossrefPubMedGoogle Scholar
  • 27 Neumann H, Diebel H, Monkemuller K. et al. Description of a new, endoscopic technique to remove the over-the-scope-clip in an ex vivo porcine model (with video). Gastrointest Endosc 2012; 76: 1009-1013
    CrossrefPubMedGoogle Scholar