Benefit of a clipping device in use in intestinal bleeding and intestinal leakage

• Published in: Gastrointestinal endoscopy 2011-08, Vol.74 (2), p.389-397
• Main Authors: Albert, Jörg G., MD, Friedrich-Rust, Mireen, MD, Woeste, Guido, MD, Strey, Christoph, MD, Bechstein, Wolf O., MD, Zeuzem, Stefan, MD, Sarrazin, Christoph, MD
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Anastomotic Leak - therapy; Biological and medical sciences; Cutaneous Fistula - therapy; Digestive system. Abdomen; Endoscopy; Endoscopy, Gastrointestinal - instrumentation; Female; Gastric Fistula - therapy; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Gastrointestinal Hemorrhage - therapy; Hemostasis, Endoscopic - instrumentation; Humans; Intestinal Fistula - therapy; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Recurrence; Retrospective Studies; Treatment Outcome
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2011.03.1128

Background The over-the-scope clip (OTSC) system was first used to close the access route in natural orifice transluminal endoscopic surgery and is increasingly used for other indications. Objective We analyzed the use of the OTSC in intestinal bleeding and in closure of GI tract leaks. Design Analysis of a consecutive series of patients. Setting University hospital. Patients Nineteen patients (group A: closure of GI leak site, n = 12; group B: complex GI bleeding, n = 7) were retrospectively enrolled in this study. We analyzed outcome and follow-up (6-68 weeks; group A: mean 37 weeks, standard deviation 24) in terms of treatment success (closure of the GI tract leak/durable hemostasis). Intervention Endoscopic application of OTSCs. Main Outcome Measurements Resolution of leaks, closure of fistula (group A), or stopping bleeding (group B). Results In group A, durable closure was achieved in 8 of 12 patients. Sealing a postoperative/postinterventional leak was successful in 6 patients and failed in 3. A gastrocutaneous fistula was primarily closed successfully in 2 patients, but recurred in 1 of these patients. A gastric wall dehiscence in necrotizing pancreatitis was successfully closed in another patient. Group B patients had previous endoscopic treatment failure in 4 of 7 patients (through-the-scope clips, injection of Suprarenin or fibrin glue, others) and were deemed not treatable by through-the-scope clips in 3 of 7 patients. The primary success rate was 100% (7 of 7 patients); durable hemostasis was achieved in 4 of 7 patients, whereas surgery or angiography was necessary in the remaining patients. Limitations Retrospective analysis. Conclusions Leaks and fistulae are reliably closed with OTSCs in tissue flexible enough to be sucked into the attached cap (eg, in lesions caused