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International multicenter experience with an over-the-scope clipping device for endoscopic management of GI defects (with video)

2014; Elsevier BV; Volume: 80; Issue: 4 Linguagem: Inglês

10.1016/j.gie.2014.03.049

1097-6779

Yamile Haito-Chavez, Joanna K. Law, Thomas Kratt, Alberto Arezzo, M. Verra, Mario Morino, Reem Z. Sharaiha, Jan‐Werner Poley, Michel Kahaleh, Christopher C. Thompson, Michele B. Ryan, Neel Choksi, B. Joseph Elmunzer, Sonia Gosain, Eric M. Goldberg, Rani J. Modayil, Stavros N. Stavropoulos, Drew Schembre, Christopher J. DiMaio, Vinay Chandrasekhara, Muhammad K. Hasan, Shyam Varadarajulu, Robert H. Hawes, Victoria Gómez, Timothy A. Woodward, Sergio Rubel-Cohen, Fernando Fluxá, Frank P. Vleggaar, Venkata S. Akshintala, Gottumukkala S. Raju, Mouen A. Khashab,

Gastrointestinal Bleeding Diagnosis and Treatment

Background The over-the-scope clip (OTSC) provides more durable and full-thickness closure as compared with standard clips. Only case reports and small case series have reported on outcomes of OTSC closure of GI defects. Objective To describe a large, multicenter experience with OTSCs for the management of GI defects. Secondary goals were to determine success rate by type of defect and type of therapy and to determine predictors of treatment outcomes. Design Multicenter, retrospective study. Setting Multiple, international, academic centers. Patients Consecutive patients who underwent attempted OTSC placement for GI defects, either as a primary or as a rescue therapy. Interventions OTSC placement to attempt closure of GI defects. Main Outcome Measurements Long-term success of the procedure. Results A total of 188 patients (108 fistulae, 48 perforations, 32 leaks) were included. Long-term success was achieved in 60.2% of patients during a median follow-up of 146 days. Rate of successful closure of perforations (90%) and leaks (73.3%) was significantly higher than that of fistulae (42.9%) (P < .05). Long-term success was significantly higher when OTSCs were applied as primary therapy (primary 69.1% vs rescue 46.9%; P = .004). On multivariate analysis, patients who had OTSC placement for perforations and leaks had significantly higher long-term success compared with those who had fistulae (OR 51.4 and 8.36, respectively). Limitations Retrospective design and multiple operators with variable expertise with the OTSC device. Conclusion OTSC is safe and effective therapy for closure of GI defects. Clinical success is best achieved in patients undergoing closure of perforations or leaks when OTSC is used for primary or rescue therapy. Type of defect is the best predictor of successful long-term closure. The over-the-scope clip (OTSC) provides more durable and full-thickness closure as compared with standard clips. Only case reports and small case series have reported on outcomes of OTSC closure of GI defects. To describe a large, multicenter experience with OTSCs for the management of GI defects. Secondary goals were to determine success rate by type of defect and type of therapy and to determine predictors of treatment outcomes. Multicenter, retrospective study. Multiple, international, academic centers. Consecutive patients who underwent attempted OTSC placement for GI defects, either as a primary or as a rescue therapy. OTSC placement to attempt closure of GI defects. Long-term success of the procedure. A total of 188 patients (108 fistulae, 48 perforations, 32 leaks) were included. Long-term success was achieved in 60.2% of patients during a median follow-up of 146 days. Rate of successful closure of perforations (90%) and leaks (73.3%) was significantly higher than that of fistulae (42.9%) (P < .05). Long-term success was significantly higher when OTSCs were applied as primary therapy (primary 69.1% vs rescue 46.9%; P = .004). On multivariate analysis, patients who had OTSC placement for perforations and leaks had significantly higher long-term success compared with those who had fistulae (OR 51.4 and 8.36, respectively). Retrospective design and multiple operators with variable expertise with the OTSC device. OTSC is safe and effective therapy for closure of GI defects. Clinical success is best achieved in patients undergoing closure of perforations or leaks when OTSC is used for primary or rescue therapy. Type of defect is the best predictor of successful long-term closure.