Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 7, 2016; 22(5): 1844-1853
Published online Feb 7, 2016. doi: 10.3748/wjg.v22.i5.1844
One hundred and one over-the-scope-clip applications for severe gastrointestinal bleeding, leaks and fistulas
Edris Wedi, Susana Gonzalez, Detlev Menke, Elena Kruse, Kai Matthes, Juergen Hochberger
Edris Wedi, Juergen Hochberger, Department of Gastroenterology, Nouvel Hôpital Civil and IHU, Strasbourg University Hospitals, F-67091 Strasbourg, France
Edris Wedi, Detlev Menke, Elena Kruse, Juergen Hochberger, Department of Medicine III - Gastroenterology, Interventional Endoscopy, St. Bernward Academic Teaching Hospital, D-31134 Hildesheim, Germany
Susana Gonzalez, Henry D Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY 10023, United States
Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children¡¯s Hospital, Harvard Medical School, Boston, MA 02115, United States
Edris Wedi, Juergen Hochberger, Section of Gastroenterology and GI Endoscopy, Interdisciplinary Center for Digestive Diseases, Strasbourg University Hospitals, Nouvel Hôpital Civil and IHU, F-67091 Strasbourg, France
Author contributions: Wedi E and Hochberger J designed and performed the study and wrote the paper; Menke D and Kruse E performed the research; Gonzalez S and Matthes K critically revised the manuscript.
Supported by The “Endo-Verein Erlangen”, a registered non-profit training organization, Baiersdorf, Germany.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board and the Ethics Committee of St. Bernward Academic Teaching Hospital Hildesheim, Germany.
Informed consent statement: All involved persons, subjects or legally authorized representative gave their informed consent (written or verbal) prior to study enrollment and treatment. Identity of all subjects including all details were anonymized.
Conflict-of-interest statement: All authors declare that there is no conflict of interest with the paper presented.
Data sharing statement: Informed consent for data sharing was not obtained but the presented data are anonymized and the risk of identification is low. No additional data are available. Questions regarding the technical appendix, statistical code and data set are available from the corresponding author at juehochber@mac.com.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Juergen Hochberger, MD, PhD, Professor, Chairman, Section of Gastroenterology and GI Endoscopy, Interdisciplinary Center for Digestive Diseases, Strasbourg University Hospitals, Nouvel Hôpital Civil and IHU, 1, place de l’Hôpital, F-67091 Strasbourg, France. juehochber@mac.com
Telephone: +33-3695-51589 Fax: +33-3695-51857
Received: April 30, 2015
Peer-review started: May 7, 2015
First decision: June 23, 2015
Revised: September 25, 2015
Accepted: December 1, 2015
Article in press: December 1, 2015
Published online: February 7, 2016
Processing time: 266 Days and 10.3 Hours
Abstract

AIM: To investigate the efficacy and clinical outcome of patients treated with an over-the-scope-clip (OTSC) system for severe gastrointestinal hemorrhage, perforations and fistulas.

METHODS: From 02-2009 to 10-2012, 84 patients were treated with 101 OTSC clips. 41 patients (48.8%) presented with severe upper-gastrointestinal (GI) bleeding, 3 (3.6%) patients with lower-GI bleeding, 7 patients (8.3%) underwent perforation closure, 18 patients (21.4%) had prevention of secondary perforation, 12 patients (14.3%) had control of secondary bleeding after endoscopic mucosal resection or endoscopic submucosal dissection (ESD) and 3 patients (3.6%) had an intervention on a chronic fistula.

RESULTS: In 78/84 patients (92.8%), primary treatment with the OTSC was technically successful. Clinical primary success was achieved in 75/84 patients (89.28%). The overall mortality in the study patients was 11/84 (13.1%) and was seen in patients with life threatning upper GI hemorrhage. There was no mortality in any other treatment group. In detail OTSC application lead to a clinical success in 35/41 (85.36%) patients with upper GI bleeding and in 3/3 patients with lower GI bleeding. Technical success of perforation closure was 100% while clinical success was seen in 4/7 cases (57.14%) due to attendant circumstances unrelated to the OTSC. Technical and clinic success was achieved in 18/18 (100%) patients for the prevention of bleeding or perforation after endoscopic mucosal resection and ESD and in 3/3 cases of fistula closure. Two application-related complications were seen (2%).

CONCLUSION: This largest single center experience published so far confirms the value of the OTSC for GI emergencies and complications. Further clinical experience will help to identify optimal indications for its targeted and prophylactic use.

Keywords: Over-the-scope-clip; Endoscopic therapy; Gastrointestinal bleeding; Perforation; Fistula

Core tip: In this retrospective study a novel endoscopic over-the-scope-clip (OTSC) was evaluated for the treatment of severe gastrointestinal bleeding, perforation and fistula. 101 OTSCs were applied in 84 patients with a primary clinical success in 75/84 patients for all applications corresponding to 89%. Severe bleeding was successfully treated in 35/41 patients with upper gastrointestinal (GI) bleeding (85.36%) and in all 3 patients with severe lower GI bleeding. Technical success of perforation closure was 100% while clinical success was seen in 4/7 cases (57.14%) due to attendant circumstances unrelated to the OTSC. Technical and clinic success was achieved in 18/18 patients for the prevention of secondary perforation or bleeding after endoscopic mucosal resection and endoscopic submucosal dissection and in 3/3 fistula closures. Two application-related complications were seen. This largest single center experience published so far confirms the high value of the OTSC for the endoscopic treatment of GI emergencies and complications.