Mangiavillano Benedetto, Caruso Angelo, Manta Raffaele, Di Mitri Roberto, Arezzo Alberto, Pagano Nico, Galloro Giuseppe, Mocciaro Filippo, Mutignani Massimiliano, Luigiano Carmelo, Antonucci Enrico, Conigliaro Rita, Masci Enzo
Benedetto Mangiavillano, Gastroenterology and Gastrointestinal Endoscopy, Borea Hospital, 18038 Sanremo, Italy.
World J Gastrointest Surg. 2016 Apr 27;8(4):315-20. doi: 10.4240/wjgs.v8.i4.315.
To determine the outcome of the management of iatrogenic gastrointestinal tract perforations treated by over-the-scope clip (OTSC) placement.
We retrospectively enrolled 20 patients (13 female and 7 male; mean age: 70.6 ± 9.8 years) in eight high-volume tertiary referral centers with upper or lower iatrogenic gastrointestinal tract perforation treated by OTSC placement. Gastrointestinal tract perforation could be with oval-shape or with round-shape. Oval-shape perforations were closed by OTSC only by suction and the round-shape by the "twin-grasper" plus suction.
Main perforation diameter was 10.1 ± 4.3 mm (range 3-18 mm). The technical success rate was 100% (20/20 patients) and the clinical success rate was 90% (18/20 patients). Two patients (10%) who did not have complete sealing of the defect underwent surgery. Based upon our observations we propose two types of perforation: Round-shape "type-1 perforation" and oval-shape "type-2 perforation". Eight (40%) out of the 20 patients had a type-1 perforation and 12 patients a type-2 (60%).
OTSC placement should be attempted after perforation occurring during diagnostic or therapeutic endoscopy. A failed closure attempt does not impair subsequent surgical treatment.
确定经内镜圈套夹（OTSC）置入治疗医源性胃肠道穿孔的疗效。
我们回顾性纳入了8家大型三级转诊中心的20例患者（13例女性，7例男性；平均年龄：70.6±9.8岁），这些患者均因医源性上消化道或下消化道穿孔接受了OTSC置入治疗。胃肠道穿孔可为椭圆形或圆形。椭圆形穿孔仅通过吸引用OTSC封闭，圆形穿孔则采用“双抓钳”加吸引的方法封闭。
主要穿孔直径为10.1±4.3mm（范围3 - 18mm）。技术成功率为100%（20/20例患者），临床成功率为90%（18/20例患者）。2例（10%）缺损未完全封闭的患者接受了手术治疗。基于我们的观察，我们提出两种类型的穿孔：圆形“1型穿孔”和椭圆形“2型穿孔”。20例患者中有8例（40%）为1型穿孔，12例（60%）为2型穿孔。
在诊断性或治疗性内镜检查过程中发生穿孔后应尝试置入OTSC。封闭尝试失败并不影响后续的手术治疗。
