Gastroenterology and Digestive Endoscopy Unit, New Civil S. Agostino Estense Hospital, Modena, Italy.
Plastic and Reconstructive Surgery, Chelsea and Westminster Hospital, London, UK.
Dig Endosc. 2017 Jul;29(5):602-607. doi: 10.1111/den.12806. Epub 2017 Feb 8.
The over-the-scope clip (OTSC) system is a recently developed endoscopic device. In the last few years, it has been successfully used for severe bleeding or deep wall lesions, or perforations of the gastrointestinal (GI) tract. We hereby report a series of patients with post-pancreaticogastrostomy pancreatic fistula in whom OTSC were used as endoscopic treatment.
From January 2012 to July 2015, we prospectively collected data on cases of postoperative pancreatic fistula. These patients underwent pancreaticoduodenectomy in a high-volume center of hepatobiliopancreatic surgery. After conservative management, OTSC closure was done by single skilled operators in anesthesiologist-assisted deep sedation.
A total of seven patients were enrolled. According to the International Study Group of Pancreatic Surgery criteria, we observed grade B postoperative pancreatic fistula in all cases. All patients were treated with 12/6 t-type OTSC. In two cases, a second clip was successfully applied to a second site adjacent to the original closure site. In all cases, subsequent fluoroscopy showed no contrastographic spreading through the wall. There were no complications related to the procedure itself, not from the endoscopy point of view, nor from the anesthesiological perspective. There were no device malfunctions. Further clinical and endoscopic evaluation was made 8 weeks later and showed no fistula or anastomotic defect recurrence. No patients required additional endoscopic or interventional procedures.
In consideration of clinical and technical success, OTSC placement in POPF seems to be effective, safe and technically relatively easy to carry out.
经内镜结扎夹（OTSC）系统是一种最近开发的内镜设备。在过去几年中，它已成功用于治疗严重出血或深壁病变或胃肠道（GI）穿孔。我们在此报告一系列经胰胃吻合术后发生胰瘘的患者，这些患者在内镜治疗中使用了 OTSC。
自 2012 年 1 月至 2015 年 7 月，我们前瞻性地收集了术后胰瘘病例的数据。这些患者在一家高容量的肝胆胰外科中心行胰十二指肠切除术。在保守治疗后，由一名熟练的内镜医生在麻醉医师辅助下进行深度镇静，使用单根 OTSC 进行夹闭。
共纳入 7 例患者。根据国际胰腺外科研究组的标准，我们观察到所有病例均为术后 B 级胰瘘。所有患者均使用 12/6 t 型 OTSC 进行治疗。在 2 例患者中，成功地在原始夹闭部位相邻的另一个部位应用了第二个夹。在所有病例中，随后的透视检查均显示造影剂未通过壁扩散。从内镜角度或麻醉学角度来看，均无与该程序本身相关的并发症。没有设备故障。8 周后进行进一步的临床和内镜评估，显示无瘘或吻合口缺陷复发。无患者需要额外的内镜或介入治疗。
考虑到临床和技术上的成功，OTSC 在 POPF 中的放置似乎是有效、安全且技术上相对容易实施的。
