Department of Surgery, University of South Alabama, Mobile, AL, USA.
Surg Endosc. 2019 Oct;33(10):3464-3468. doi: 10.1007/s00464-018-06646-1. Epub 2019 Jan 16.
Endoscopic over the scope clip (OTSC) closure represents a new technique for endoscopic management of enteric bleeding and tissue defects such as anastomotic leaks and enterocutaneous (EC) fistulas. We aim to describe our technical approach for OTSC closure of EC fistulas and convey our outcomes.
This retrospective review includes ten patients who underwent OTSC application for EC fistulas by surgical endoscopists at a US tertiary care hospital from July 2015 to October 2017. Demographic data, along with type of defect, location, duration of lesion, success or failure of OTSC, and nutritional status were compiled. The ACS NSQIP surgical risk calculator was used to project the risk of mortality, complications, length of stay, and risk of readmission had our patients undergone surgical correction of their fistula.
Overall success for EC fistula closure was 70%. Acute fistulas were closed with a success rate of 86%. Chronic fistulas were closed successfully in only 33% of cases. Of patients successfully closed, NSQIP-predicted rates of mortality, any complication, and median length of stay were 21.1%, 34.5%, and 9.5 days, respectively. With OTSC, these patients experienced 0 mortalities, 0 complications, and had a median length of stay of 4 days.
OTSC is an effective adjunctive measure to improving rates of successful closure of EC fistulas and compromised anastomosis. OTSC conveys a markedly improved procedural risk profile as compared to standard surgical correction.
内镜下套扎夹（OTSC）闭合术代表了一种治疗肠内出血和组织缺损（如吻合口漏和肠外瘘）的内镜新方法。我们旨在描述我们用于 OTSC 闭合肠外瘘的技术方法，并报告我们的结果。
这项回顾性研究包括 2015 年 7 月至 2017 年 10 月期间，美国一家三级护理医院的外科内镜医生对 10 例肠外瘘患者进行 OTSC 应用的病例。收集了人口统计学数据，以及缺陷类型、位置、病变持续时间、OTSC 的成功或失败以及营养状况。使用 ACS NSQIP 手术风险计算器来预测我们的患者接受瘘管手术矫正的死亡率、并发症、住院时间和再入院风险。
肠外瘘闭合的总体成功率为 70%。急性瘘管的闭合成功率为 86%。慢性瘘管仅成功闭合 33%。在成功闭合的患者中，NSQIP 预测的死亡率、任何并发症和中位住院时间分别为 21.1%、34.5%和 9.5 天。使用 OTSC，这些患者没有死亡，没有并发症，中位住院时间为 4 天。
OTSC 是提高肠外瘘和受损吻合口成功闭合率的有效辅助措施。与标准手术矫正相比，OTSC 可显著改善手术风险状况。
