Background and aim: Gastro-intestinal acute perforation and bleeding are potentially life-threatening emergencies and could be treated endoscopically by using metallic clips. However clips have limits with regard to compression of tissue, especially in scarred and hardened tissue or inflammatory mucosa. Recently, a novel clip device, the over-the-scope clip (OTSC) (OVESCO®) system has been developed to treat these patients. Clinical experiences in case series with the OTSC clip is however actually limited. Aim of our study is to retrospectively evaluate the usefulness of OTSC clip in the upper and lower GI acute perforation, leaks and bleeding. Material and methods: OTSC is a self-retracting clip made of nitinol, installed on a silicon straight cap that can be mounted on the tip of endoscope. The OTSC has two jaws that move separately to approximate the edges of the GI wall, to close the defect or stopping the bleeding. It can be released by turning a handle that is attached to the biopsy channel of the endoscope, similarly to endoscopic variceal ligation. Accessories used to close the defect are the “twin-grasper” and the “anchor”. To stop haemorrage only aspiration is usually needed. Seventeen patients were retrospectively evaluated. There were 7 leaks, 4 acute iatrogenic perforation and 6 bleedings. Results: All of the 7 leakage had good clinical course obtaining the complete sealing. Three of the 4 acute perforations had good clinical course with immediate closure of the wall defect, only one patient underwent surgical intervention. All of the 6 patients had stop bleeding after OTSC placement and no re-bleeding were observed. Conclusions: In our experience, including leak, iatrogenic acute perforation and bleeding, OTSC was a successful technique in the 94.1% of the cases. The major advantage of OTSC clips seems to be their ability to grasp more tissue compared to the standard clips and their strong grip on the lesions margins, because of their teeth. It could be create an advantage in the operative endoscopic techniques for the treatment of different cases that otherwise required surgery.
Over the scope clip (OTSC) in upper and lower gastrointestinal perforation, leak and bleeding: clinical experience.
Mangiavillano B;
2013-01-01
Abstract
Background and aim: Gastro-intestinal acute perforation and bleeding are potentially life-threatening emergencies and could be treated endoscopically by using metallic clips. However clips have limits with regard to compression of tissue, especially in scarred and hardened tissue or inflammatory mucosa. Recently, a novel clip device, the over-the-scope clip (OTSC) (OVESCO®) system has been developed to treat these patients. Clinical experiences in case series with the OTSC clip is however actually limited. Aim of our study is to retrospectively evaluate the usefulness of OTSC clip in the upper and lower GI acute perforation, leaks and bleeding. Material and methods: OTSC is a self-retracting clip made of nitinol, installed on a silicon straight cap that can be mounted on the tip of endoscope. The OTSC has two jaws that move separately to approximate the edges of the GI wall, to close the defect or stopping the bleeding. It can be released by turning a handle that is attached to the biopsy channel of the endoscope, similarly to endoscopic variceal ligation. Accessories used to close the defect are the “twin-grasper” and the “anchor”. To stop haemorrage only aspiration is usually needed. Seventeen patients were retrospectively evaluated. There were 7 leaks, 4 acute iatrogenic perforation and 6 bleedings. Results: All of the 7 leakage had good clinical course obtaining the complete sealing. Three of the 4 acute perforations had good clinical course with immediate closure of the wall defect, only one patient underwent surgical intervention. All of the 6 patients had stop bleeding after OTSC placement and no re-bleeding were observed. Conclusions: In our experience, including leak, iatrogenic acute perforation and bleeding, OTSC was a successful technique in the 94.1% of the cases. The major advantage of OTSC clips seems to be their ability to grasp more tissue compared to the standard clips and their strong grip on the lesions margins, because of their teeth. It could be create an advantage in the operative endoscopic techniques for the treatment of different cases that otherwise required surgery.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
