Chavan Radhika, Nabi Zaheer, Karayampudi Arun, Jagtap Nitin, Asif Shujaath, Yaralagadda Raghvendra, Basha Jahangeer, Lakhtakia Sundeep, Tandan Manu, Ramchandani Mohan, Reddy D Nageshwar
Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India.
Ann Gastroenterol. 2020 Sep-Oct;33(5):473-479. doi: 10.20524/aog.2020.0515. Epub 2020 Jun 30.
Recent advances in endoscopic tools and techniques have allowed the minimally invasive management of iatrogenic gastrointestinal (GI) perforations and bleedings. However, surgery may be required in cases with larger defects and bleeding refractory to conventional endoscopic modalities. The use of over-the-scope clips (OTSC) has been shown to improve the outcomes in these patients compared with conventional treatment modalities. In this study, we evaluated the safety and efficacy of OTSC for different indications in the GI tract.
The data of consecutive patients in whom OTSC was utilized for different indications between February 2017 and October 2019 were analyzed retrospectively. The following outcomes were recorded: technical and clinical success, and adverse events related to the procedure.
Thirty-six patients (22 male, mean age 52.673±14.97 years, range 11-72 years) underwent OTSC application. Indications for OTSC were: GI defects (perforation n=13, fistula n=5); esophageal metallic stent fixing n=9; GI bleeding n=8; and neuroendocrine tumor endotherapy n=1. The average size of the defect was 15.88±8.01 mm. The technical and clinical success rates were 88.89% and 83.33%, respectively. There were 4 (11.1%) technical failures: colonic perforations n=2; duodenal ulcer bleeding n=1; and esophageal metal stent fixation n=1. There were 2 (9.5%) adverse events, including 1 partial duodenal obstruction and 1 delayed bleeding.
The use of OTSC is safe, easy and effective for various indications in the GI tract. Prospective trials are required to see if the use of OTSC is cost effective as a primary endoscopic treatment method in these cases.
内镜工具和技术的最新进展使得医源性胃肠道（GI）穿孔和出血能够得到微创治疗。然而，对于较大缺损以及对传统内镜治疗方式难以控制的出血情况，可能仍需进行手术治疗。与传统治疗方式相比，使用套扎型内镜夹（OTSC）已被证明可改善这些患者的治疗效果。在本研究中，我们评估了OTSC在胃肠道不同适应证中的安全性和有效性。
回顾性分析了2017年2月至2019年10月期间连续使用OTSC治疗不同适应证患者的数据。记录了以下结果：技术成功率和临床成功率，以及与该操作相关的不良事件。
36例患者（22例男性，平均年龄52.673±14.97岁，范围11 - 72岁）接受了OTSC应用。OTSC的适应证包括：胃肠道缺损（穿孔n = 13，瘘管n = 5）；食管金属支架固定n = 9；胃肠道出血n = 8；神经内分泌肿瘤内镜治疗n = 1。缺损的平均大小为15.88±8.01毫米。技术成功率和临床成功率分别为88.89%和83.33%。有4例（11.1%）技术失败：结肠穿孔n = 2；十二指肠溃疡出血n = 1；食管金属支架固定n = 1。有2例（9.5%）不良事件，包括1例部分十二指肠梗阻和1例延迟出血。
OTSC在胃肠道各种适应证中的使用安全、简便且有效。需要进行前瞻性试验，以确定在这些病例中，OTSC作为主要内镜治疗方法是否具有成本效益。
