Jayaraman Vijay, Hammerle Christoper, Lo Simon K, Jamil Laith, Gupta Kapil
Cedars Sinai Medical Center, Los Angeles, CA 90048, USA.
Diagn Ther Endosc. 2013;2013:381873. doi: 10.1155/2013/381873. Epub 2013 Jul 14.
Background. OTSCs are now available in the US for various indications. Methods. Retrospective review of OTSCs used from January 2011 to April 2012. Results. Twenty-four patients underwent placement of 28 OTSCs. Indications included postsurgical fistula, perforations, anastomotic leak, prophylactic closure after EMR, postpolypectomy bleeding, tracheoesophageal fistula, and jejunostomy site leak. Instruments used to grasp the tissue were dedicated (bidirectional forceps or tripronged device) and nondedicated devices (rat/alligator forceps or suction). Success was higher with nondedicated devices (12.5% versus 86.5%, P = 0.0004). Overall, OTSC was effective in 15/27 procedures. Defect closure was complete in 12/21. Mean followup was 2.9 months (1-8 m). Mean defect size was 10 mm (5-25 mm). A trend towards higher success was noted in defects <10 mm compared to defects >10 mm (90% versus 60%; P = 0.36). No difference was noted in closure of fresh (<72 hrs) versus chronic defects (>1 month) (75% versus 67%). There were no complications. Conclusion. The OTSC provides a safe alternative to manage fistula, perforation, and bleeding. No significant difference was seen for closure of early fistula or perforations as compared to chronic fistula. Rat-tooth forceps or suction was superior to the dedicated devices.
背景。OTSCs（Over-the-Scope Clips，内镜下金属夹）目前在美国可用于多种适应症。方法。回顾性分析2011年1月至2012年4月使用OTSCs的情况。结果。24例患者植入了28枚OTSCs。适应症包括术后瘘、穿孔、吻合口漏、内镜下黏膜切除术（EMR）后的预防性封闭、息肉切除术后出血、气管食管瘘和空肠造口部位漏。用于抓取组织的器械有专用器械（双向钳或三爪装置）和非专用器械（鼠齿钳/鳄嘴钳或吸引器）。使用非专用器械的成功率更高（12.5%对86.5%，P = 0.0004）。总体而言，OTSCs在27例手术中的15例有效。21例中的12例缺损完全闭合。平均随访时间为2.9个月（1 - 8个月）。平均缺损大小为10毫米（5 - 25毫米）。与缺损>10毫米相比，缺损<10毫米时成功率有升高趋势（90%对60%；P = 0.36）。新鲜缺损（<72小时）与慢性缺损（>1个月）的闭合情况无差异（75%对67%）。无并发症发生。结论。OTSCs为处理瘘、穿孔和出血提供了一种安全的替代方法。早期瘘或穿孔的闭合与慢性瘘相比无显著差异。鼠齿钳或吸引器优于专用器械。
