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International multicenter experience with an over-the-scope clipping device for endoscopic management of GI defects (with video) - 17/09/14

Doi : 10.1016/j.gie.2014.03.049 
Yamile Haito-Chavez, MD 1, Joanna K. Law, MD 1, Thomas Kratt, MD 2, Alberto Arezzo, MD 3, Mauro Verra, MD 3, Mario Morino, MD 3, Reem Z. Sharaiha, MD 4, Jan-Werner Poley, MD 5, Michel Kahaleh, MD 4, Christopher C. Thompson, MD 6, Michele B. Ryan, MS 6, Neel Choksi, MD 7, B. Joseph Elmunzer, MD 7, Sonia Gosain, MD 8, Eric M. Goldberg, MD 8, Rani J. Modayil, MD 9, Stavros N. Stavropoulos, MD 9, Drew B. Schembre, MD 10, Christopher J. DiMaio, MD 11, Vinay Chandrasekhara, MD 12, Muhammad K. Hasan, MD 13, Shyam Varadarajulu, MD 13, Robert Hawes, MD 13, Victoria Gomez, MD 14, Timothy A. Woodward, MD 14, Sergio Rubel-Cohen, MD 15, Fernando Fluxa, MD 15, Frank P. Vleggaar, MD 16, Venkata S. Akshintala, MD 1, Gottumukkala S. Raju, MD 17, Mouen A. Khashab, MD 1, ⁎
1 Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA 
2 Department of General, Visceral and Transplant Surgery, University Hospital of Tübingen, Tübingen, Germany 
3 Department of Surgical Sciences, University of Torino, Torino, Italy 
4 Department of Internal Medicine, Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA 
5 Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands 
6 Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts, USA 
7 Division of Gastroenterology, University of Michigan Medical Center, Ann Arbor, Michigan, USA 
8 Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD, USA 
9 Division of Gastroenterology, Hepatology and Nutrition, Winthrop University Hospital, Mineola, New York, USA 
10 Swedish Gastroenterology, Swedish Medical Center, Seattle, Washington, USA 
11 Division of Gastroenterology, The Mount Sinai Medical Center, New York, New York, USA 
12 Gastroenterology Division, Department of Internal Medicine, University of Pennsylvania Health System, Philadelphia, PA, USA 
13 Center for Interventional Endoscopy, Florida Hospital, Orlando, Florida, USA 
14 Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Jacksonville, Florida, USA 
15 Department of Gastroenterology, Clinica Las Condes, Universidad de Chile, Santiago, Chile 
16 Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands 
17 Department of Gastroenterology, Hepatology, and Nutrition, University of Texas MD Anderson Cancer Center, Houston, Texas, USA 

∗Reprint requests: Mouen Khashab, MD, Sheikh Zayed Tower, Johns Hopkins Hospital, Suite 7125B, 1800 Orleans Street, Baltimore, MD 21287.

Abstract

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.

Il testo completo di questo articolo è disponibile in PDF.

Abbreviations : APC, OTSC, SEMS


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 DISCLOSURE: M. Khashab is a consultant for Boston Scientific and Olympus America and received research funding from Cook Medical. J.-W. Poley is a consultant for Cook Medical and Boston Scientific. C. Thompson is a consultant for Apollo Endosurgery. E. Goldberg is a consultant for Olympus America and Boston Scientific. D. Schembre has a royalty agreement with and is on the speakers' bureau for Cook Medical and is a consultant for Boston Scientific. M. Hasan is a consultant for Boston Scientific. S. Varadarajulu is a consultant for Boston Scientific and Olympus America. R. Hawes is a consultant for Boston Scientific, Cook Medical, and Olympus America. All other authors disclosed no financial relationships relevant to this publication.
 See CME section; p. 679.


© 2014  American Society for Gastrointestinal Endoscopy. Pubblicato da Elsevier Masson SAS. Tutti i diritti riservati.
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