One hundred and one over-the-scope-clip applications forsevere gastrointestinal bleeding,leaks and fistulas  

作　　者：Edris Wedi Susana Gonzalez Detlev Menke Elena Kruse Kai Matthes Juergen Hochberger 

机构地区：[1]Department of Gastroenterology,Nouvel Hôpital Civil and IHU,Strasbourg University Hospitals,F-67091 Strasbourg,France [2]Department of Medicine III-Gastroenterology,Interventional Endoscopy,St.Bernward Academic Teaching Hospital,D-31134 Hildesheim,Germany [3]Henry D Janowitz Division of Gastroenterology,Icahn School of Medicine at Mount Sinai,New York,NY 10023,United States [4]Department of Anesthesiology,Perioperative and Pain Medicine,Boston Children’s Hospital,Harvard Medical School,Boston,MA 02115,United States [5]Section of Gastroenterology and GI Endoscopy,Interdisciplinary Center for Digestive Diseases,Strasbourg University Hospitals,Nouvel Hôpital Civil and IHU,F-67091 Strasbourg,France

出　　处：《World Journal of Gastroenterology》2016年第5期1844-1853,共10页世界胃肠病学杂志（英文版）

基　　金：Supported by The“Endo-Verein Erlangen”;a registered non-profit training organization;Baiersdorf;Germany

摘　　要：AIM: To investigate the efficacy and clinical outcome of patients treated with an over-the-scope-clip(OTSC) system for severe gastrointestinal hemorrhage, perforations and fistulas.METHODS: From 02-2009 to 10-2012, 84 patients were treated with 101 OTSC clips. 41 patients(48.8%) presented with severe upper-gastrointestinal(GI) bleeding, 3(3.6%) patients with lower-GI bleeding, 7 patients(8.3%) underwent perforation closure, 18 patients(21.4%) had prevention of secondary perforation, 12 patients(14.3%) had control of secondary bleeding after endoscopic mucosal resection or endoscopic submucosal dissection(ESD) and 3 patients(3.6%) had an intervention on a chronic fistula. RESULTS: In 78/84 patients(92.8%), primary treatment with the OTSC was technically successful. Clinical primary success was achieved in 75/84 patients(89.28%). The overall mortality in the study patients was 11/84(13.1%) and was seen in patients with life threatning upper GI hemorrhage. There was no mortality in any other treatment group. In detail OTSC application lead to a clinical success in 35/41(85.36%) patients with upper GI bleeding and in 3/3 patients with lower GI bleeding. Technical success of perforation closure was 100% while clinical success was seen in 4/7 cases(57.14%) due to attendant circumstances unrelated to the OTSC. Technical and clinic success was achieved in 18/18(100%) patients for the prevention of bleeding or perforation after endoscopic mucosal resection and ESD and in 3/3 cases of fistula closure. Two application-related complications were seen(2%).CONCLUSION: This largest single center experience published so far confirms the value of the OTSC for GI emergencies and complications. Further clinical experience will help to identify optimal indications for its targeted and prophylactic use.AIM: To investigate the efficacy and clinical outcome of patients treated with an over-the-scope-clip(OTSC) system for severe gastrointestinal hemorrhage, perforations and fistulas.METHODS: From 02-2009 to 10-2012, 84 patients were treated with 101 OTSC clips. 41 patients(48.8%) presented with severe upper-gastrointestinal(GI) bleeding, 3(3.6%) patients with lower-GI bleeding, 7 patients(8.3%) underwent perforation closure, 18 patients(21.4%) had prevention of secondary perforation, 12 patients(14.3%) had control of secondary bleeding after endoscopic mucosal resection or endoscopic submucosal dissection(ESD) and 3 patients(3.6%) had an intervention on a chronic fistula. RESULTS: In 78/84 patients(92.8%), primary treatment with the OTSC was technically successful. Clinical primary success was achieved in 75/84 patients(89.28%). The overall mortality in the study patients was 11/84(13.1%) and was seen in patients with life threatning upper GI hemorrhage. There was no mortality in any other treatment group. In detail OTSC application lead to a clinical success in 35/41(85.36%) patients with upper GI bleeding and in 3/3 patients with lower GI bleeding. Technical success of perforation closure was 100% while clinical success was seen in 4/7 cases(57.14%) due to attendant circumstances unrelated to the OTSC. Technical and clinic success was achieved in 18/18(100%) patients for the prevention of bleeding or perforation after endoscopic mucosal resection and ESD and in 3/3 cases of fistula closure. Two application-related complications were seen(2%).CONCLUSION: This largest single center experience published so far confirms the value of the OTSC for GI emergencies and complications. Further clinical experience will help to identify optimal indications for its targeted and prophylactic use.

关 键 词：Over-the-scope-clip Endoscopic therapy Gastrointestinal bleeding Perforation Fistula 

分 类 号：R57[医药卫生—消化系统]