TY - JOUR
T1 - International multicenter experience with an over-the-scope clipping device for endoscopic management of GI defects (with video)
AU - Haito-Chavez, Yamile
AU - Law, Joanna K.
AU - Kratt, Thomas
AU - Arezzo, Alberto
AU - Verra, Mauro
AU - Morino, Mario
AU - Sharaiha, Reem Z.
AU - Poley, Jan Werner
AU - Kahaleh, Michel
AU - Thompson, Christopher C.
AU - Ryan, Michele B.
AU - Choksi, Neel
AU - Elmunzer, B. Joseph
AU - Gosain, Sonia
AU - Goldberg, Eric M.
AU - Modayil, Rani J.
AU - Stavropoulos, Stavros N.
AU - Schembre, Drew B.
AU - Di Maio, Christopher J.
AU - Chandrasekhara, Vinay
AU - Hasan, Muhammad K.
AU - Varadarajulu, Shyam
AU - Hawes, Robert
AU - Gomez, Victoria
AU - Woodward, Timothy A.
AU - Rubel-Cohen, Sergio
AU - Fluxa, Fernando
AU - Vleggaar, Frank P.
AU - Akshintala, Venkata S.
AU - Raju, Gottumukkala S.
AU - Khashab, Mouen A.
N1 - Publisher Copyright:
Copyright © 2014 by the American Society for Gastrointestinal Endoscopy.
PY - 2014/10/1
Y1 - 2014/10/1
N2 - 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.
AB - 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.
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U2 - 10.1016/j.gie.2014.03.049
DO - 10.1016/j.gie.2014.03.049
M3 - Article
C2 - 24908191
AN - SCOPUS:84922462489
SN - 0016-5107
VL - 80
SP - 610
EP - 622
JO - Gastrointestinal endoscopy
JF - Gastrointestinal endoscopy
IS - 4
ER -