Preventing Rescue Surgeries by Endoscopic Clipping: A Valuable Resource in the Surgeon's Toolbox

Shanglei Liu, Garth R. Jacobsen, Bryan J. Sandler, Thomas J. Savides, Syed Fehmi, Hans Fuchs, Ran B. Luo, Jonathan C. Delong, Alisa Coker, Caitlin Houghton, Santiago Horgan

Research output: Contribution to journalArticle

Abstract

Aim: Over-the-scope-clip (OTSC) System is a relatively new endoluminal intervention for gastrointestinal (GI) leaks, fistulas, and bleeding. Here, we present a single center experience with the device over the course of 4 years. Methods: Retrospective chart review was conducted for patients who received endoscopic OTSC treatment. Primary outcome is the resolution of the original indication for clip placement. Secondary outcomes are complications and time to resolution. Results: Forty-one patients underwent treatment with the OTSC system from 2011 to 2015 with average follow-up of 152 days. The average age is 53.7. The most common site of clip placement was in the stomach (44%). Clips were placed after surgical complication for 28 patients (68%), endoscopic complications for 8 patients (19%), and spontaneous presentation in 5 patients (12%). Technical success was achieved in all patients. Overall, 34 patients (83%) were successfully treated. Nine patients required multiple clips and three patients required additional treatment modalities after OTSC. Four patients used the OTSC as a bridging therapy to surgery. Using OTSC for palliation versus nonpalliative indications was associated with lower rates of treatment success (50% versus 86%, P = .028). Using OTSC for symptoms <6 months had higher rates of treatment success than those experiencing longer symptoms (88% versus 65%, P = .045). There were no major morbidities or mortalities directly associated with the OTSC system. Complications from clip use were pain in two patients (5%) and hematemesis in one patient (3%). Conclusions: The OTSC System can be a very successful treatment for iatrogenic or spontaneous GI leaks and bleeds. Treatment success is more likely in patients treated within 6 months of diagnosis and less likely to when used for palliation. It was also successfully used as bridging therapy in several patients.

Original languageEnglish (US)
Pages (from-to)439-444
Number of pages6
JournalJournal of Laparoendoscopic and Advanced Surgical Techniques
Volume28
Issue number4
DOIs
StatePublished - Apr 1 2018
Externally publishedYes

Fingerprint

Surgical Instruments
Therapeutics
Surgeons
Hematemesis
Fistula
Stomach
Hemorrhage

Keywords

  • endoscopic clip
  • endoscopic treatment
  • gastrointestinal leak
  • gastrointestinal perforation

ASJC Scopus subject areas

  • Surgery

Cite this

Preventing Rescue Surgeries by Endoscopic Clipping : A Valuable Resource in the Surgeon's Toolbox. / Liu, Shanglei; Jacobsen, Garth R.; Sandler, Bryan J.; Savides, Thomas J.; Fehmi, Syed; Fuchs, Hans; Luo, Ran B.; Delong, Jonathan C.; Coker, Alisa; Houghton, Caitlin; Horgan, Santiago.

In: Journal of Laparoendoscopic and Advanced Surgical Techniques, Vol. 28, No. 4, 01.04.2018, p. 439-444.

Research output: Contribution to journalArticle

Liu, S, Jacobsen, GR, Sandler, BJ, Savides, TJ, Fehmi, S, Fuchs, H, Luo, RB, Delong, JC, Coker, A, Houghton, C & Horgan, S 2018, 'Preventing Rescue Surgeries by Endoscopic Clipping: A Valuable Resource in the Surgeon's Toolbox', Journal of Laparoendoscopic and Advanced Surgical Techniques, vol. 28, no. 4, pp. 439-444. https://doi.org/10.1089/lap.2017.0167
Liu, Shanglei ; Jacobsen, Garth R. ; Sandler, Bryan J. ; Savides, Thomas J. ; Fehmi, Syed ; Fuchs, Hans ; Luo, Ran B. ; Delong, Jonathan C. ; Coker, Alisa ; Houghton, Caitlin ; Horgan, Santiago. / Preventing Rescue Surgeries by Endoscopic Clipping : A Valuable Resource in the Surgeon's Toolbox. In: Journal of Laparoendoscopic and Advanced Surgical Techniques. 2018 ; Vol. 28, No. 4. pp. 439-444.
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AU - Savides, Thomas J.

AU - Fehmi, Syed

AU - Fuchs, Hans

AU - Luo, Ran B.

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