Endoscopic closure of gastric perforation using over-the-scope clip: a surgery-sparing approach

Singhal, Shashideep; Atluri, Sreedevi; Changela, Kinesh; Gupta, Shubhra S.; Krishnaiah, Mahesh; Anand, Sury

doi:10.1016/j.gie.2013.07.050

Cited by 5 publications

(2 citation statements)

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“…Type ‘gc’ with a long pointed tooth appearance (papa bear) is the preferred choice for closure of fistulae and larger perforations of the upper gastrointestinal tract. The standard method for loading and deploying the OTSC was described by us previously [Singhal et al 2014]. The hand wheel is mounted on the working side channel of the endoscope and attached to the preloaded applicator cap by a thread passing through the channel.…”

Section: Methodsmentioning

confidence: 99%

Endoscopic closure of persistent gastrocutaneous fistulae, after percutaneous endoscopic gastrostomy (PEG) tube placement, using the over-the-scope-clip system

Singhal

Changela

Culliford

et al. 2015

Therap Adv Gastroenterol

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Objectives:The Over-The-Scope-Clip (OTSC) has had an evolving role in endoscopic closure of gastrointestinal wall defects, in hemostasis of primary or postinterventional bleeding, and approximation of postbariatric surgery defects. Rapid and effective closure of gastrocutaneous (GC) fistulae using this device has been recently described in the literature. The aim of this study was to evaluate the technical feasibility, efficacy and safety of OTSC as an effective tool in the management of persistent GC fistulae secondary to a complication of percutaneous endoscopic gastrostomy (PEG) tube placement. Method: In this multicenter prospective observational study, we describe our experience with OTSC in the closure of persistent GC fistulas secondary to PEG tube placement. Patients with GC fistulas were sequentially enrolled with a mean age of 84 years. Primary treatment outcome was the immediate successful closure of GC fistula and resolution of leak. Secondary outcome was no recurrence of the fistula and leaks on follow up. Results: A total of 10 patients were enrolled over the study period. Mean age was 84.4 ± 8.75 years. The primary treatment outcome was achieved in all the patients undergoing this intervention. Secondary outcome was observed in 9/10 (90%) subjects. No procedural complications were reported. Larger fistulae (>2.5 cm) and those with significant fibrosis were more difficult to close with the OTSC system. The mean follow-up time after OTSC application was 43.7 ± 20.57 days. A limitation of this study was that there was no control group. Conclusions: OTSC application is a safe and effective endoscopic approach for the closure of persistent GC fistulae secondary to a complication of PEG tube placement.

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Section: Methodsmentioning

confidence: 99%

Endoscopic closure of persistent gastrocutaneous fistulae, after percutaneous endoscopic gastrostomy (PEG) tube placement, using the over-the-scope-clip system

Singhal

Changela

Culliford

et al. 2015

Therap Adv Gastroenterol

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“…Gastric defects greater than 1 cm has been managed with omental patch prior to clip application (79). Larger defects are managed with OTS clips and clip-loop method which utilizes multiple peripheral TTS clips for approximation (93). OverStitch (Apollo Endosurgery Inc., Austin, TX, USA) has been shown in small series to be effective in the management of marginal ulcers and gastric defects following ESD (94,95).…”

Section: Preferred Endoscopic Modalities For Gi Defects Perforationsmentioning

confidence: 99%

Endoscopic management of perforations, leaks and fistulas

Singh

Nussbaum

Kumta

2018

Transl. Gastroenterol. Hepatol

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The endoscopic management armamentarium of gastrointestinal disruptions including perforations, leaks, and fistulas has slowly but steadily broadened in recent years. Previously limited to surgical or conservative medical management, innovations in advanced endoscopic techniques like natural orifice transluminal endoscopic surgery (NOTES) have paved the path towards development of endoscopic closure techniques. Early recognition of a gastrointestinal defect is the most important independent variable in determining successful endoscopic closure and patient outcome. Some devices including through the scope clips and stents have been well studied for other indications and have produced encouraging results in closure of gastrointestinal perforations, leaks and fistulas. Over the scope clips, endoscopic sutures, vacuum therapy, glue, and cardiac device occluders are other alternative techniques that can be employed for successful endoscopic closure.

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