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Fukui H, Dohi O, Hirose T, Furukawa K, Tashima T, Tada N, Ichinona T, Asai S, Kobara H, Itoh Y. Clinical outcomes of the over-the-scope clip closure after duodenal endoscopic submucosal dissection: A multicenter retrospective study. J Gastroenterol Hepatol 2024; 39:725-732. [PMID: 38229468 DOI: 10.1111/jgh.16464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 11/20/2023] [Accepted: 12/05/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND AND AIM Prophylactic closure with the over-the-scope clip (OTSC) after endoscopic submucosal dissection (ESD) of superficial non-ampullary duodenal epithelial tumors (SNADETs) has been reported to reduce postoperative adverse events (AEs). However, there are few evidences regarding AEs-associated factors and long-term outcomes of OTSCs. METHODS From January 2011 to December 2020, 139 consecutive patients with SNADETs who underwent ESD followed by OTSC closure in five institutions were extracted in this retrospective study. The primary endpoint was the rate of postoperative AEs after prophylactic OTSC closure. The secondary endpoints were the complete closure rate, residual rate, and long-term AEs associated with residual OTSCs. RESULTS The rate of complete closure of the mucosal defect was 97.3% (142) in 146 SNADETs, which were completely resected by ESD. Postoperative AEs, including delayed bleeding, delayed perforation, and localized peritonitis, occurred in 6.2%, 3.4%, and 2.1% of patients, respectively; however, all of the cases improved without surgical treatment. In the multivariate logistic regression analysis, the use of two or more OTSCs was a significant independent risk factor for postoperative AEs (odds ratio, 2.94; 95% confidence interval, 1.02-8.46; P = 0.046). The residual OTSC rate was 46.4% at 1 year postoperatively, and long-term AEs included duodenal erosions and ulcers associated with residual OTSCs. CONCLUSIONS Prophylactic closure with OTSCs after duodenal ESD can provide acceptable short-and long-term outcomes for preventing postoperative AEs. However, multiple OTSCs were the independent risk factors of postoperative AEs due to the gaps between and near the OTSCs.
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Affiliation(s)
- Hayato Fukui
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Osamu Dohi
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takashi Hirose
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuhiro Furukawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomoaki Tashima
- Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Naoya Tada
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Takumi Ichinona
- Department of Gastroenterology, Tane General Hospital, Osaka, Japan
| | - Satoshi Asai
- Department of Gastroenterology, Tane General Hospital, Osaka, Japan
| | - Hideki Kobara
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Yoshito Itoh
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Blasberg T, Hochberger J, Meiborg M, Jung C, Weber M, Brunk T, Leifeld L, Seif Amir Hosseini A, Wedi E. Prophylactic clipping using the over-the-scope clip (OTSC) system after complex ESD and EMR of large colon polyps. Surg Endosc 2023; 37:7520-7529. [PMID: 37418148 DOI: 10.1007/s00464-023-10235-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/18/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Delayed bleeding is the most frequent complication after endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) of large colon polyps. Today, prophylactic clipping with through-the-scope clips (TTSCs) is commonly used to reduce the risk of bleeding. However, the over-the-scope clip (OTSC) system might be superior to TTSCs in achieving hemostasis. This study aims to evaluate the efficacy and safety of prophylactic clipping using the OTSC system after ESD or EMR of large colon polyps. METHODS This is a retrospective analysis of a prospective collected database from 2009 until 2021 of three endoscopic centers. Patients with large (≥ 20 mm) colon polyps were enrolled. All polyps were removed by either ESD or EMR. After the resection, OTSCs were prophylactically applied on parts of the mucosal defect with a high risk of delayed bleeding or/and perforation. The main outcome measurement was delayed bleeding. RESULTS A total of 75 patients underwent ESD (67%, 50/75) or EMR (33%, 25/75) in the colorectum. The mean resected specimen diameter was 57 mm ± 24.1 (range 22-98 mm). The mean number of OTSCs placed on the mucosal defect was 2 (range 1-5). None of the mucosal defects were completely closed. Intraprocedural bleeding occurred in 5.3% (ESD 2.0% vs. EMR 12.0%; P = 0.105), and intraprocedural perforation occurred in 6.7% (ESD 8% vs. EMR 4%; P = 0.659) of the patients. Hemostasis was achieved in 100% of cases of intraprocedural bleeding, whereas two patients required surgical conversion due to intraprocedural perforation. Among the remaining 73 patients who received prosphylactic clipping, delayed bleeding occurred in 1.4% (ESD 0% vs. EMR 4.2%; P = 0.329), and delayed perforation occurred in 0%. CONCLUSIONS The prophylactic partial closure of large post-ESD/EMR mucosal defects using OTSCs could serve as an effective strategy to reduce the risk of delayed bleeding and perforation. The prophylactic partial closure of large complex post-ESD/EMR mucosal defects using OTSCs could serve as an effective strategy to reduce the risk of delayed bleeding and perforation.
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Affiliation(s)
- T Blasberg
- Division of Gastroenterology, Gastrointestinal Oncology and Interventional Endoscopy, Sana Clinic Offenbach, Starkenburgring 66, 63069, Offenbach, Germany
| | - J Hochberger
- Department of Gastroenterology, Vivantes Hospital Friedrichshain Berlin, Berlin, Germany
| | - M Meiborg
- Division of Gastroenterology, Gastrointestinal Oncology and Interventional Endoscopy, Sana Clinic Offenbach, Starkenburgring 66, 63069, Offenbach, Germany
| | - C Jung
- Clinic for Gastroenterology, Gastrointestinal Oncology and Endocrinology, University of Göttingen, Göttingen, Germany
| | - M Weber
- Division of Gastroenterology, Gastrointestinal Oncology and Interventional Endoscopy, Sana Clinic Offenbach, Starkenburgring 66, 63069, Offenbach, Germany
| | - T Brunk
- Department of Gastroenterology, Vivantes Hospital Friedrichshain Berlin, Berlin, Germany
| | - L Leifeld
- Department of Internal Medicine III, St. Bernward Hospital, Hildesheim, Germany
| | - A Seif Amir Hosseini
- Department of Diagnostic and Interventional Radiology, University Medical Center Göttingen, Göttingen, Germany
| | - E Wedi
- Division of Gastroenterology, Gastrointestinal Oncology and Interventional Endoscopy, Sana Clinic Offenbach, Starkenburgring 66, 63069, Offenbach, Germany.
- Clinic for Gastroenterology, Gastrointestinal Oncology and Endocrinology, University of Göttingen, Göttingen, Germany.
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Ou YH, Kong WF, Li LF, Chen PS, Deng SH, He FJ, Peng QQ, Yue H. Methods for Endoscopic Removal of Over-the-Scope Clip: A Systematic Review. Can J Gastroenterol Hepatol 2020; 2020:5716981. [PMID: 32908852 DOI: 10.1155/2020/5716981] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 02/07/2020] [Accepted: 08/18/2020] [Indexed: 02/06/2023] Open
Abstract
AIMS The over-the-scope clip (OTSC) has recently emerged as a new endoscopic device for treating gastrointestinal bleeding, perforations, fistulas, and leaks. A modified OTSC device (full-thickness resection device, FTRD) has been widely used for endoscopic full-thickness resection. However, there is less experience regarding the indications and methods for OTSC removal. We aimed to summarize the existing methods and indications for OTSC removal. METHODS We searched PubMed, Cochrane Library, and ClinicalTrials.gov to identify relevant publications on OTSC removal. The details of OTSC removal, including the methods, indications, success rates, adverse events, and failure causes, were extracted and summarized. A meta-analysis of pooled success rates was conducted using STATA 15.0. RESULTS Eighteen articles were included. The reported methods for OTSC removal included (1) grasping forceps, (2) the Nd : YAG laser, (3) argon plasma coagulation, (4) the remOVE system, (5) endoscopic mucosal resection/endoscopic submucosal dissection, and (6) ice-cold saline solution. Indications for OTSC removal were (1) poor healing, (2) OTSC misplacement, (3) repeat biopsy/therapy or further treatment, (4) adverse events after OTSC implantation, (5) removal after recovery, and (6) patient wishes. The pooled success rate of OTSC removal was 89% in patients treated with the remOVE system. Minor bleeding, superficial thermal damage, and superficial mucosal tears were common adverse events. Mucosal overgrowth was the main cause of OTSC removal failure. CONCLUSIONS The remOVE system is the best investigated method, with sufficient efficacy and safety for OTSC removal. This is the first systematic review of OTSC removal and provides significant guidance for clinical practice.
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Andrisani G, Pizzicannella M, Martino M, Rea R, Pandolfi M, Taffon C, Caricato M, Coppola R, Crescenzi A, Costamagna G, Di Matteo FM. Endoscopic full-thickness resection of superficial colorectal neoplasms using a new over-the-scope clip system: A single-centre study. Dig Liver Dis 2017; 49:1009-13. [PMID: 28539229 DOI: 10.1016/j.dld.2017.04.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 04/18/2017] [Accepted: 04/24/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM Endoscopic full-thickness resection (EFTR) provides complete en-bloc resection with a histopathological evaluation of submucosal, muscular, and serosal layers. The aim of this study was to investigate the efficacy and safety of a novel over-the-scope device for colorectal EFTR. MATERIAL AND METHODS In this retrospective, observational, open-label case study, a total of 20 patients with superficial colorectal neoplasms, underwent EFTR using a new endoscopic full-thickness resection device (FTRD; Ovesco Endoscopy, Tübingen, Germany). Endoscopic treatment outcomes (technical success, rate of EFTR, adverse events) and early follow-up at three months, were analyzed. RESULTS We reported a 100% of technical success, defined as full-thickness resection. Among the R1 resections, histology was negative for neoplasm. Non-lifting adenomas had histology positive for adenocarcinoma: seven T1/G1/sm1; one T1/G1/sm2; one, who underwent a surgical resection, T1/G1/sm3. Mean size of the resected lesions was 26mm, ranging from 10 to 42mm. One (5%) patient developed abdominal pain, fever and leukocytosis and was treated conservatively with medical therapy. In all specimens, histological complete resection was confirmed. CONCLUSIONS EFTR is a feasible and effective technique that could become a valid alternative to EMR and ESD in the management of recurrent adenomas, no-lifting lesions and scars of R1 resections. However, prospective studies are needed to further evaluate the device and technique.
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Caputo A, Schmidt A, Caca K, Bauerfeind P, Schostek S, Ho CN, Gottwald T, Schurr MO. Efficacy and safety of the remOVE System for OTSC ® and FTRD ® clip removal: data from a PMCF analysis. MINIM INVASIV THER 2017; 27:138-142. [PMID: 28608741 DOI: 10.1080/13645706.2017.1335643] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The remOVE System (Ovesco Endoscopy AG, Tuebingen, Germany) is a medical device for the endoscopic removal of OTSC or FTRD clips (Ovesco Endoscopy AG, Tuebingen, Germany). The aim of this paper is to assess the efficacy and safety of this system. MATERIAL AND METHODS A total of 74 patients underwent clip extraction. The standard removal procedure comprises fragmenting the clip by applying an electrical direct current pulse at two opposing sides of the clip. RESULTS Clip fragmentation was successful in 72 of 74 patients (97.3%). In two cases (2.7%) clip fragmentation was not possible. In nine cases (12.2%) a clip fragment could not be removed and was left in place. Complications occurred in three cases (4.1%): two minor bleedings near the clip removal site (2.7%), and one superficial mucosal tear resulting from clip fragment extraction (1.4%). DISCUSSION Based on this study, the use of the remOVE System for OTSC or FTRD clip removal can be considered safe and effective.
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Affiliation(s)
| | - Arthur Schmidt
- b Department of Gastroenterology and Oncology , Klinikum Ludwigsburg , Ludwigsburg , Germany
| | - Karel Caca
- b Department of Gastroenterology and Oncology , Klinikum Ludwigsburg , Ludwigsburg , Germany
| | - Peter Bauerfeind
- c Department of Gastroenterology and Hepatology , University Hospital , Zurich , Switzerland
| | | | | | - Thomas Gottwald
- a Ovesco Endoscopy AG , Tuebingen , Germany.,d Medical Faculty , University of Tuebingen , Germany
| | - Marc O Schurr
- a Ovesco Endoscopy AG , Tuebingen , Germany.,e IHCI-Institute , Steinbeis University Berlin , Tuebingen , Germany
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Khater S, Rahmi G, Perrod G, Samaha E, Benosman H, Abbes L, Malamut G, Cellier C. Over-the-scope clip (OTSC) reduces surgery rate in the management of iatrogenic gastrointestinal perforations. Endosc Int Open 2017; 5:E389-E394. [PMID: 28508033 PMCID: PMC5429170 DOI: 10.1055/s-0043-104862] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background and study aims Over-the-scope clip (OTSC) has been recently used in management of gastrointestinal perforations, but data on it are still limited. The aim of this study was to compare management of iatrogenic perforations before and after the OTSC was available in our endoscopy unit. Patients and methods We conducted a monocentric retrospective study from June 2007 to June 2015. All iatrogenic gastrointestinal perforations detected during endoscopy were included. Two time periods were compared in terms of surgery and mortality rates: before use of OTSC (June 2007 to June 2011) and after OTSC became available (June 2011 to June 2015). Results During the first period, 24 perforations were recorded. Fifteen (62.5 %) were managed with surgery. The mortality rate was 8 %. During the second period, 16 perforations occurred. In 11 patients (68.7 %), an OTSC was used to close the perforation, with complete sealing of the perforation in 100 % of cases. However, 2 patients with sigmoid perforation had to undergo surgery due to right ureteral obstruction by the clip in 1 case and to presence of a localized peritonitis in the other. The surgery rate during this period was 12.5 % (2 /16), with a statistically significant difference compared to the first period (P = 0.002). There was no mortality in the second period versus 8 % in the first one (P = 0.23). Conclusions OTSC is effective for endoluminal closure of iatrogenic perforations and results in a significant decrease in surgery rate.
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Affiliation(s)
- Sherine Khater
- Department of Gastroenterology and Digestive Endoscopy, Georges Pompidou European Hospital, Assistance Publique – Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, Paris, France,Corresponding author Sherine Khater, MD Department of Gastroenterology and Digestive EndoscopyGeorges Pompidou European Hospital20 rue Leblanc75015 ParisFrance+33-1-56-09-29-14
| | - Gabriel Rahmi
- Department of Gastroenterology and Digestive Endoscopy, Georges Pompidou European Hospital, Assistance Publique – Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Guillaume Perrod
- Department of Gastroenterology and Digestive Endoscopy, Georges Pompidou European Hospital, Assistance Publique – Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Elia Samaha
- Department of Gastroenterology and Digestive Endoscopy, Georges Pompidou European Hospital, Assistance Publique – Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Hedi Benosman
- Department of Gastroenterology and Digestive Endoscopy, Georges Pompidou European Hospital, Assistance Publique – Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Leila Abbes
- Department of Gastroenterology and Digestive Endoscopy, Georges Pompidou European Hospital, Assistance Publique – Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Georgia Malamut
- Department of Gastroenterology and Digestive Endoscopy, Georges Pompidou European Hospital, Assistance Publique – Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Christophe Cellier
- Department of Gastroenterology and Digestive Endoscopy, Georges Pompidou European Hospital, Assistance Publique – Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
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Meier B, Caca K, Schmidt A. Hybrid endoscopic mucosal resection and full-thickness resection: a new approach for resection of large non-lifting colorectal adenomas (with video). Surg Endosc 2017; 31:4268-4274. [PMID: 28281119 DOI: 10.1007/s00464-017-5461-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 02/03/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Clip-assisted endoscopic full-thickness resection (EFTR) with an over-the-scope device has been recently described to be feasible and effective for the resection of non-lifting adenomas in the lower gastrointestinal tract. However, tumor size is the major limitation of that technique. We describe a hybrid technique using endoscopic mucosal resection (EMR) in ten patients with large non-lifting colorectal adenomas to reduce tumor size and facilitate clip-assisted EFTR. METHODS Data of ten consecutive patients (median age 72.5 years, SD 8.86) who underwent combined EMR and EFTR in the colon were analyzed retrospectively. The main outcome measures were technical success, histological confirmation of full-thickness resection, and adverse events. RESULTS All lesions (median size 35.5 mm, SD 5.99) could be resected successfully. No immediate or delayed adverse events were observed. Histology confirmed full-thickness resection in all cases. Three-month follow-up showed no residual or recurrent adenomas. CONCLUSIONS Hybrid EMR-EFTR in the colon seems to be an effective approach for large non-lifting lesions with positive lateral lifting signs. Prospective studies are needed to further evaluate efficacy, safety, rate of recurrence, and long-term outcome of this technique.
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Affiliation(s)
- Benjamin Meier
- Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Posilipostraße 4, 71640, Ludwigsburg, Germany.
| | - Karel Caca
- Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Posilipostraße 4, 71640, Ludwigsburg, Germany
| | - Arthur Schmidt
- Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Posilipostraße 4, 71640, Ludwigsburg, Germany
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Richter-Schrag HJ, Walker C, Thimme R, Fischer A. [Full thickness resection device (FTRD). Experience and outcome for benign neoplasms of the rectum and colon]. Chirurg 2017; 87:316-25. [PMID: 26438202 DOI: 10.1007/s00104-015-0091-z] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The diagnostic validity of a full-thickness resection is higher compared to endoscopic mucosal resection (EMR) or endoscopic mucosal dissection (ESD). Whereas transanal endoscopic microsurgery techniques (TEM, TAMIS) are established therapeutic procedures in the rectum no established and safe minimally invasive or endoscopic procedure exists in the colon. AIM In this study the novel endoscopic full thickness resection device (FTRD, Ovesco, Germany) was investigated concerning success rates with histologically proven full thickness resections, R0 status as well as patient and device safety for the rectum and colon. METHOD In the period from November 2014 to June 2015 full thickness resections in the rectum and colon were performed with the FTRD in 20 patients. Data on technical success, R0 resection rate and histologically confirmed full thickness resections were retrospectively analyzed. RESULTS The following indications were treated in the rectum (n = 11) and colon (n = 9): T1 carcinoma (n = 6) and neuroendocrine tumors (n = 2), untreated and nonlifting adenomas (n = 3) and incomplete resection of adenomas with low and high grade dysplasia (n = 9). The technical success rate was 75 %, 3 technical failures made a conventional polypectomy necessary in 2 patients and in 1 patient an operative resection of the duplicated intestinal wall had to be performed. The median endoscopic follow-up time was 61.5 days (n = 10) and in 7 patients the clip had dislodged at the first follow-up. A thermal perforation in one case of conventional polypectomy gave rise to indications for a partial resection of the colon. In one patient the lesion in the cecum could be reached but not treated for technical reasons. The histological R0 rate was 80 %, whereas the full thickness resection rate was 60 % (85.7 % in the colon and 54.6 % in the rectum). In two patients with carcinoma and incomplete FTRD, surgical treatment was performed. The median size of the resection specimen was 5 cm(2) (range 1.6-12.9 cm(2)). CONCLUSION The results show that FTRD is a safe and effective instrument for use in the lower gastrointestinal tract. Limitations of the FTRD system concerning full thickness resection are scarring, fibrosis and thickness of the intestinal wall, especially in the lower rectum; therefore, it is suggested that a simulation with a tube similar in size to the FTRD should be performed during the screening colonoscopy in order to establish whether an endoscopic resection with FTRD is possible.
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Affiliation(s)
- H-J Richter-Schrag
- Interdisziplinäre Gastrointestinale Endoskopie, Kliniken für Innere Medizin II, Universitätsklinik Freiburg, Sir Hans A. Krebs Strasse, 79106, Freiburg im Breisgau, Deutschland.
| | - C Walker
- Interdisziplinäre Gastrointestinale Endoskopie, Kliniken für Innere Medizin II, Universitätsklinik Freiburg, Sir Hans A. Krebs Strasse, 79106, Freiburg im Breisgau, Deutschland
| | - R Thimme
- Interdisziplinäre Gastrointestinale Endoskopie, Kliniken für Innere Medizin II, Universitätsklinik Freiburg, Sir Hans A. Krebs Strasse, 79106, Freiburg im Breisgau, Deutschland
| | - A Fischer
- Interdisziplinäre Gastrointestinale Endoskopie, Kliniken für Innere Medizin II, Universitätsklinik Freiburg, Sir Hans A. Krebs Strasse, 79106, Freiburg im Breisgau, Deutschland
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Bauder M, Meier B, Caca K, Schmidt A. Endoscopic removal of over-the-scope clips: Clinical experience with a bipolar cutting device. United European Gastroenterol J 2016; 5:479-484. [PMID: 28588877 DOI: 10.1177/2050640616671846] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 09/05/2016] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Over-the-scope clips (OTSCs) are increasingly used for the closure of perforations/fistulae, hemostasis and endoscopic full-thickness resection (FTRD system). When OTSC-associated complications occur or re-therapy at the OTSC site is needed, OTSC removal may be indicated. An experimental study in an animal model and a case series have shown good results for OTSC removal with a bipolar cutting device. We present a larger clinical study using this device. METHODS Data of all consecutive patients with indication for OTSC removal were collected and analyzed retrospectively. OTSCs were cut at two opposing sites using a bipolar grasping device to apply short direct current impulses. OTSC fragments were extracted with a standard forceps and a cap at the tip of the endoscope to avoid tissue damage. RESULTS Between December 2012 and February 2016 a total of 42 OTSC removals in the upper (n = 25) and lower (n = 17) gastrointestinal tract have been performed at our department. Overall technical success, defined as cutting the OTSC at two opposing sites and extraction of both fragments, was achieved in 92.9% (39/42) of all cases. Successful fragmentation of the OTSC was achieved in 97.6% (41/42). Minor bleedings were rare and could be managed endoscopically in all cases. There were no perforations and no major or delayed bleedings. CONCLUSION Endoscopic OTSC removal with a bipolar cutting device is feasible, effective and safe. This technique can be applied in the upper and lower gastrointestinal tract.
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Affiliation(s)
- Markus Bauder
- Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Benjamin Meier
- Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Karel Caca
- Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Arthur Schmidt
- Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany
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Mayerle J, Greinacher A. Interventional Endoscopy--Opportunities and Limitations. Dtsch Arztebl Int 2016; 113:119-20. [PMID: 26976711 DOI: 10.3238/arztebl.2016.0119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Julia Mayerle
- Department of Internal Medicine A, University Medicine Greifswald, Ernst-Moritz-Arndt University of Greifswald, Department of Transfusion Medicine, Institute for Immunology and Transfusion Medicine, University Medicine Greifswald, Ernst-Moritz-Arndt University of Greifswald
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Abstract
With mortality due to gastrointestinal (GI) bleeding remaining stable, the focus on endoscopic hemostasis has been on improving other outcomes such as rebleeding rate, need for transfusions, and need for angiographic embolization or surgery. Over the past few years, a number of devices have emerged to help endoscopically assess and treat bleeding GI lesions. These include the Doppler endoscopic probe, hemostatic powder, and over-the-scope clip. Also, new applications have been described for radiofrequency ablation. In this article, we will discuss these evolving tools and techniques that have been developed, including an analysis of their efficacy and limitations.
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Affiliation(s)
- Kevin A. Ghassemi
- Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA,CURE Hemostasis Research Group
| | - Dennis M. Jensen
- Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA,CURE Hemostasis Research Group,Division of Gastroenterology, VA Greater Los Angeles Healthcare Center, Los Angeles, CA, USA
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Abstract
BACKGROUND AND AIMS Endoscopic resection of duodenal non-lifting adenomas and subepithelial tumors is challenging and harbors a significant risk of adverse events. We report on a novel technique for duodenal endoscopic full-thickness resection (EFTR) by using an over-the-scope device. METHODS Data of 4 consecutive patients who underwent duodenal EFTR were analyzed retrospectively. Main outcome measures were technical success, R0 resection, histologic confirmation of full-thickness resection, and adverse events. Resections were done with a novel, over-the-scope device (full-thickness resection device, FTRD). RESULTS Four patients (median age 60 years) with non-lifting adenomas (2 patients) or subepithelial tumors (2 patients) underwent EFTR in the duodenum. All lesions could be resected successfully. Mean procedure time was 67.5 minutes (range 50-85 minutes). Minor bleeding was observed in 2 cases; blood transfusions were not required. There was no immediate or delayed perforation. Mean diameter of the resection specimen was 28.3 mm (range 22-40 mm). Histology confirmed complete (R0) full-thickness resection in 3 of 4 cases. To date, 2-month endoscopic follow-up has been obtained in 3 patients. In all cases, the over-the-scope clip was still in place and could be removed without adverse events; recurrences were not observed. CONCLUSIONS EFTR in the duodenum with the FTRD is a promising technique that has the potential to spare surgical resections. Modifications of the device should be made to facilitate introduction by mouth. Prospective studies are needed to further evaluate efficacy and safety for duodenal resections.
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Affiliation(s)
- Arthur Schmidt
- Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Benjamin Meier
- Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Oscar Cahyadi
- Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Karel Caca
- Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany
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