Sulz Michael Christian, Bertolini Reto, Frei Remus, Semadeni Gian-Marco, Borovicka Jan, Meyenberger Christa
Michael Christian Sulz, Reto Bertolini, Remus Frei, Gian-Marco Semadeni, Jan Borovicka, Christa Meyenberger, Division of Gastroenterology and Hepatology, 9007 Gallen, Switzerland.
World J Gastroenterol. 2014 Nov 21;20(43):16287-92. doi: 10.3748/wjg.v20.i43.16287.
To evaluate the outcome of over-the-scope-clip system (OTSC) for endoscopic treatment of various indications in daily clinical practice in Switzerland.
This prospective, consecutive case series was conducted at a tertiary care hospital from September 2010 to January 2014. Indications for OTSC application were fistulae, anastomotic leakage, perforation, unroofed submucosal lesion for biopsy, refractory bleeding, and stent fixation in the gastrointestinal (GI) tract. Primary technical success was defined as the adequate deployment of the OTSC on the target lesion. Clinical success was defined as resolution of the problem; for instance, no requirement for surgery or further endoscopic intervention. In cases of recurrence, retreatment of a lesion with a second intervention was possible. Complications were classified into those related to sedation, endoscopy, or deployment of the clip.
A total of 28 OTSC system applications were carried out in 21 patients [median age 64 years (range 42-85), 33% females]. The main indications were fistulae (52%), mostly after percutaneous endoscopic gastrostomy tube removal, and anastomotic leakage after GI surgery (29%). Further indications were unroofed submucosal lesions after biopsy, upper gastrointestinal bleeding, or esophageal stent fixation. The OTSC treatments were applied either in the upper (48%) or lower (52%) GI tract. The mean lesion size was 8 mm (range: 2-20 mm). Primary technical success and clinical success rates were 85% and 67%, respectively. In 53% of cases, the suction method was used without accessories (e.g., twin grasper or tissue anchor). No endoscopy-related or OTSC-related complications were observed.
OTSC is a useful tool for endoscopic closure of various GI lesions, including fistulae and leakages. Future randomized prospective multicenter trials are warranted.
评估套扎式内镜夹系统（OTSC）在瑞士日常临床实践中对各种适应症进行内镜治疗的效果。
本前瞻性、连续性病例系列研究于2010年9月至2014年1月在一家三级护理医院进行。OTSC的应用适应症包括瘘管、吻合口漏、穿孔、活检的无顶黏膜下病变、难治性出血以及胃肠道（GI）支架固定。主要技术成功定义为OTSC在目标病变上的充分部署。临床成功定义为问题的解决；例如，无需手术或进一步的内镜干预。在复发的情况下，可对病变进行二次干预再治疗。并发症分为与镇静、内镜检查或夹子部署相关的并发症。
共对21例患者进行了28次OTSC系统应用[中位年龄64岁（范围42 - 85岁），33%为女性]。主要适应症为瘘管（52%），大多在经皮内镜胃造瘘管拔除后，以及胃肠道手术后的吻合口漏（29%）。其他适应症包括活检后的无顶黏膜下病变、上消化道出血或食管支架固定。OTSC治疗应用于上消化道（48%）或下消化道（52%）。平均病变大小为8毫米（范围：2 - 20毫米）。主要技术成功率和临床成功率分别为85%和67%。在53%的病例中，使用了无附件（如双抓钳或组织锚）的吸引方法。未观察到与内镜检查相关或与OTSC相关的并发症。
OTSC是内镜闭合各种胃肠道病变（包括瘘管和漏口）的有用工具。未来有必要进行随机前瞻性多中心试验。
