Clin Endosc.  2014 Mar;47(2):178-182. 10.5946/ce.2014.47.2.178.

Endoscopic Treatment of Various Gastrointestinal Tract Defects with an Over-the-Scope Clip: Case Series from a Tertiary Referral Hospital

• Lee WC
• Ko WJ
• Cho JH
• Lee TH
• Jeon SR
• Kim HG
• Cho JY

• KMID: 2049006
• DOI: http://doi.org/10.5946/ce.2014.47.2.178

Abstract

Recently, increasingly invasive therapeutic endoscopic procedures and more complex gastrointestinal surgeries such as endoscopic mucosal resection, endoscopic submucosal dissection, and novel laparoscopic approaches have resulted in endoscopists being confronted more frequently with perforations, fistulas, and anastomotic leakages, for which nonsurgical closure is desired. In this article, we present our experiences with the use of over-the-scope clip (OTSC) for natural orifice transluminal endoscopic surgery (NOTES) closure, prevention of perforation, anastomotic leakages, and fistula closures. The OTSC is a valuable device for closing intestinal perforations and fistulas, for NOTES closure, and for the prevention of perforation after the excision of a tumor from the proper muscle layer. Furthermore, it seems to be quite safe to perform, even by endoscopists with little experience of the technique.

Keyword

Over-the-scope clip; Natural orifice endoscopic surgery; Fistula; Subepithelial tumor; Anastomosis

MeSH Terms

Anastomotic Leak
Fistula
Gastrointestinal Tract*
Intestinal Perforation
Natural Orifice Endoscopic Surgery
Tertiary Care Centers*

Figure

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  Fig. 1 (A) Colonoscopic findings of dye leakage from a colon fistula on the transverse colon. (B) No dye leakage occurred after over-the-scope clip closure.

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  Fig. 2 (A) Endoscopic findings of early gastric cancer with submucosal invasion located on the angle. (B) Postendoscopic full-thickness gastric resection and closure with three over-the-scope clips.

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  Fig. 3 (A) Endoscopic findings of a subepithelial tumor on the cardia. (B) The proper muscle layer is visibly exposed after tumorectomy. (C) Endoscopic ultrasonography findings of tumor raised from the proper muscle layer. (D) One over-the-scope clip was placed on the tumorectomy lesion to prevent perforation.

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