Over-the-scope-clip (OTSC) in the management of perforations in diagnostic and therapeutic endoscopy: results from the italian multicentrc study (OIMS).

Background and aim: Iatrogenic perforations that occur during the endoscopic procedures are generally surgically managed, even if some authors prefer a non-surgical approach in selected cases but results limited in patients with comorbid conditions. Incidence of perforation during diagnostic endoscopy is reported to be between 0.01% and 0.6% and therapeutic endoscopy between 0.6% and 5.5%. By using over the scope clip (OTSC) the immediate closure of these perforations would be possible during endoscopy. Material and methods: We retrospectively enrolled 14 patients (9F and 5M; mean age: 71.1±10.3ys) in 6 tertiary referral Italian center with upper and lower GI tract perforation after diagnostic or therapeutic endoscopy treated by over the scope clip (OTSC) application. Results: Site was: 3 stomach; 3 duodenum; 2 jejunum; 1 cecum; 1 ascending colon; 4 sigmoid colon. 8 perforations occurred during diagnostic endoscopy (3 during EUS; 3 during colonoscopy in diverticulitis and 2 in a Billroth 2 with duodenoscope) and 6 during therapeutic one (4 during EMR and 2 during ESD). Utilized OTSC clips were: 1 of 9 mm diameter, 6 of 10 mm and 7 of 11 mm. Technical success was of 100% (14/14 pts) and clinical success was of 92.8% (13/14 pts). One of the patients (7.2%) had a not complete sealing of the duodenal perforation and underwent hepatico-jejunostomy with surgical defect repair. Excluding the patient underwent surgery the mean time for discharge was of: 5.8±1 days. Conclusions: Considering the high rate of technical and clinical success in sealing perforations of the GI tract, an attempt of OTSC placement have to be performed after perforation occurred during diagnostic or therapeutic endoscopy, also in minor endoscopic center but with an adequate training. It allows a short time of hospital stay and results in minor hospital costs.