RESUMO
Background and Objectives: To assist in achieving optimal position when deploying over-the-scope (OTS)-clips, the concept of cannulating the defect with a guidewire, backloading the endoscope onto the wire, and firing the OTS-clip over the wire with subsequent wire removal has been demonstrated. The safety of this technique has not been evaluated. Methods: An ex-vivo porcine foregut model was utilized. Biopsy punches were used to create 3-mm diameter full-thickness gastrointestinal tract defects through which a guidewire was threaded. An endoscope was backloaded over the wire and OTS-clips (OVESCO, Tuebingen, Germany) were fired over the mucosal defect and wire. The wire was removed through the endoscope and the removal difficulty was graded using a Likert scale. This process was repeated for each unique combination of nine OTS-clip types, two wire types, four wire angles, and three tissue types. Statistical analysis included t test and ANOVA. Results: Two hundred sixteen OTS-clip firings with wire removal attempts were performed with the following Likert score breakdown: 1 - No difficulty (80.6%), 2 - mild difficulty (16.2%), 3 - moderate difficulty (2.3%), 4 - extreme difficulty (0.9%), and 5 - unable to remove (0%). Statistically significant differences were noted in removal difficulty between OTS-clip sizes (p < 0.05). No differences were identified between clip teeth types, wire types, tissue types, and wire angles (p > 0.05). Conclusion: In this ex-vivo model, the guidewire was successfully removed through the endoscope in all cases. This technique can be employed to facilitate OTS-clip closure of gastrointestinal tract defects, but further study is indicated before wide clinical implementation.
Assuntos
Endoscópios , Instrumentos Cirúrgicos , Suínos , AnimaisRESUMO
INTRODUCTION AND AIM: Enteric perforations and fistulas are difficult to manage due to comorbidities, poor nutritional status, and anatomic challenges related to multiple interventions in those patients. The use of endoscopic methods as a nonsurgical approach is increasing. The aim of the present study was to describe the clinical experience with the use of the Ovesco Over-The-Scope Clip system in the closure of perforations, fistulas, and other indications in the digestive tract at a tertiary care hospital center. MATERIALS AND METHODS: A case series was carried out on patients that underwent lesion closure with the Ovesco clip, within the time frame of January 2015 to December 2017. RESULTS: The Ovesco clip was used for closure in 14 patients ranging in age from 21-90 years, with different indications: iatrogenic perforations; anastomotic leaks and fistulas; tracheoesophageal fistulas; and esophagogastric perforation. Technical success was achieved in 100% of the patients and clinical success in 78.57%. No complications were reported. CONCLUSIONS: The Ovesco Over-The-Scope Clip system is a safe and effective method for managing gastrointestinal acute perforations and fistulas.
Assuntos
Endoscopia Gastrointestinal/instrumentação , Endoscopia Gastrointestinal/métodos , Fístula/cirurgia , Gastroenteropatias/cirurgia , Perfuração Intestinal/cirurgia , Gastropatias/cirurgia , Instrumentos Cirúrgicos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Centros de Atenção Terciária , Resultado do Tratamento , Adulto JovemRESUMO
Resumen Introducción: las perforaciones o fístulas del tracto gastrointestinal (TGI) plantean un gran reto terapéutico y usualmente son de manejo quirúrgico. Con la introducción de nuevos accesorios endoscópicos, el gastroenterólogo cada vez más tiene que manejar a estos pacientes. El sistema over-the-scope clip (OTSC) (Ovesco) ha mostrado utilidad en el cierre de perforaciones del TGI de varias causas. Métodos: este trabajo presenta una serie de casos prospectiva, conducida en un centro de endoscopia de tercer nivel en Bogotá, Colombia, durante el año 2015 en el que se muestra la experiencia con el uso del sistema OTSC, en 6 pacientes con diferentes indicaciones. Los pacientes fueron seguidos mínimo 3 meses para valorar recurrencia. Resultados: se recopilaron 6 casos, 3 hombres y 3 mujeres, con un promedio de edad de 46,6 años, cuyas indicaciones fueron: perforación rectal, fístula gastrocutánea posterior a gastrostomía percutánea, fístula gástrica posterior a cirugía bariátrica, resección transmural del cáncer gástrico con el clip, fístula rectovaginal y perforación duodenal traumática. Se logró el cierre exitoso de la lesión en 5 de los 6 casos, con una tasa de éxito de 83,3%. Conclusiones: el sistema OTSC es un sistema útil para el cierre de perforaciones del TGI de diversas etiologías, mostrando mayor eficacia en el cierre de perforaciones agudas. No siendo útil en lesiones crónicas como la fístula rectovaginal. También puede ser útil en nuevas opciones como la resección transmural del cáncer gástrico temprano.
Abstract Perforations and fistulas of the gastrointestinal tract pose great therapeutic challenges and have usually been treated surgically. Recently, introduction of new endoscopic accessories has resulted in a growing trend of gastroenterological management of these patients. The "over-the-scope clip" (OTSC) system has shown itself to be useful for closing perforations of the gastrointestinal tract resulting from various causes. Methods: This paper presents a prospective case series of patients at a third level endoscopy center in Bogotá, Colombia who were treated in 2015. Experience with the use of the OTSC system in six patients with different indications is presented with at least three months of follow-up to assess recurrence. Results: Six cases, three men and three women, whose average age was 46.6 years were treated for a rectal perforation, a gastrocutaneous fistula following percutaneous gastrostomy, a posterior gastric fistula following bariatric surgery, gastric cancer through transmural clip resection, a rectal-vaginal fistula, and traumatic duodenal perforation. Successful closure of the lesion was achieved in five of the six cases, with a success rate of 83.3%. Conclusions: The OTSC system is useful system for closure of perforations of diverse etiologies in the gastrointestinal tract and is very efficient for closure of acute perforations. Nevertheless, it is not useful for chronic lesions such as rectal-vaginal fistulas. It may also be useful for new options such as transmural resection of early gastric cancer.