Over-the-scope clip management of non-acute, full-thickness gastrointestinal defects

David J. Morrell, Joshua S. Winder, Ansh Johri, Salvatore Docimo, Ryan M. Juza, Samantha R. Witte, Vamsi Alli, Eric Pauli

Research output: Contribution to journalArticle

Abstract

Background: Endoscopic management of full-thickness gastrointestinal tract defects (FTGID) has become an attractive management strategy, as it avoids the morbidity of surgery. We have previously described the short-term outcomes of over-the-scope clip management of 22 patients with non-acute FTGID. This study updates our prior findings with a larger sample size and longer follow-up period. Methods: A retrospective analysis of prospectively collected data was conducted. All patients undergoing over-the-scope clip management of FTGID between 2013 and 2019 were identified. Acute perforations immediately managed and FTGID requiring endoscopic suturing were excluded. Patient demographics, endoscopic adjunct therapies, number of endoscopic interventions, and need for operative management were evaluated. Success was strictly defined as complete FTGID closure. Results: We identified 92 patients with 117 FTGID (65 fistulae and 52 leaks); 27.2% had more than one FTGID managed simultaneously. The OTSC device (Ovesco Endoscopy, Tubingen, Germany) was utilized in all cases. Additional closure attempts were required in 22.2% of defects. With a median follow-up period of 5.5 months, overall defect closure success rate was 66.1% (55.0% fistulae vs. 79.6% leaks, p = 0.007). There were four mortalities from causes unrelated to the FTGID. Only 14.9% of patients with FTGID underwent operative management. There were no complications related to endoscopic intervention and no patients required urgent surgical intervention. Conclusions: Over-the-scope clip management of FTGID represents a safe alternative to potentially morbid operative intervention. When strictly defining success as complete closure of all FTGID, endoscopy was successful in 64.4% of patients with only a small minority of patients ultimately requiring surgery.

Original languageEnglish (US)
JournalSurgical endoscopy
DOIs
StatePublished - Jan 1 2019

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Surgical Instruments
Gastrointestinal Tract
Endoscopy
Fistula
Sample Size
Germany
Demography
Morbidity
Equipment and Supplies
Mortality

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Morrell, David J. ; Winder, Joshua S. ; Johri, Ansh ; Docimo, Salvatore ; Juza, Ryan M. ; Witte, Samantha R. ; Alli, Vamsi ; Pauli, Eric. / Over-the-scope clip management of non-acute, full-thickness gastrointestinal defects. In: Surgical endoscopy. 2019.
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abstract = "Background: Endoscopic management of full-thickness gastrointestinal tract defects (FTGID) has become an attractive management strategy, as it avoids the morbidity of surgery. We have previously described the short-term outcomes of over-the-scope clip management of 22 patients with non-acute FTGID. This study updates our prior findings with a larger sample size and longer follow-up period. Methods: A retrospective analysis of prospectively collected data was conducted. All patients undergoing over-the-scope clip management of FTGID between 2013 and 2019 were identified. Acute perforations immediately managed and FTGID requiring endoscopic suturing were excluded. Patient demographics, endoscopic adjunct therapies, number of endoscopic interventions, and need for operative management were evaluated. Success was strictly defined as complete FTGID closure. Results: We identified 92 patients with 117 FTGID (65 fistulae and 52 leaks); 27.2{\%} had more than one FTGID managed simultaneously. The OTSC device (Ovesco Endoscopy, Tubingen, Germany) was utilized in all cases. Additional closure attempts were required in 22.2{\%} of defects. With a median follow-up period of 5.5 months, overall defect closure success rate was 66.1{\%} (55.0{\%} fistulae vs. 79.6{\%} leaks, p = 0.007). There were four mortalities from causes unrelated to the FTGID. Only 14.9{\%} of patients with FTGID underwent operative management. There were no complications related to endoscopic intervention and no patients required urgent surgical intervention. Conclusions: Over-the-scope clip management of FTGID represents a safe alternative to potentially morbid operative intervention. When strictly defining success as complete closure of all FTGID, endoscopy was successful in 64.4{\%} of patients with only a small minority of patients ultimately requiring surgery.",
author = "Morrell, {David J.} and Winder, {Joshua S.} and Ansh Johri and Salvatore Docimo and Juza, {Ryan M.} and Witte, {Samantha R.} and Vamsi Alli and Eric Pauli",
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Over-the-scope clip management of non-acute, full-thickness gastrointestinal defects. / Morrell, David J.; Winder, Joshua S.; Johri, Ansh; Docimo, Salvatore; Juza, Ryan M.; Witte, Samantha R.; Alli, Vamsi; Pauli, Eric.

In: Surgical endoscopy, 01.01.2019.

Research output: Contribution to journalArticle

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T1 - Over-the-scope clip management of non-acute, full-thickness gastrointestinal defects

AU - Morrell, David J.

AU - Winder, Joshua S.

AU - Johri, Ansh

AU - Docimo, Salvatore

AU - Juza, Ryan M.

AU - Witte, Samantha R.

AU - Alli, Vamsi

AU - Pauli, Eric

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Y1 - 2019/1/1

N2 - Background: Endoscopic management of full-thickness gastrointestinal tract defects (FTGID) has become an attractive management strategy, as it avoids the morbidity of surgery. We have previously described the short-term outcomes of over-the-scope clip management of 22 patients with non-acute FTGID. This study updates our prior findings with a larger sample size and longer follow-up period. Methods: A retrospective analysis of prospectively collected data was conducted. All patients undergoing over-the-scope clip management of FTGID between 2013 and 2019 were identified. Acute perforations immediately managed and FTGID requiring endoscopic suturing were excluded. Patient demographics, endoscopic adjunct therapies, number of endoscopic interventions, and need for operative management were evaluated. Success was strictly defined as complete FTGID closure. Results: We identified 92 patients with 117 FTGID (65 fistulae and 52 leaks); 27.2% had more than one FTGID managed simultaneously. The OTSC device (Ovesco Endoscopy, Tubingen, Germany) was utilized in all cases. Additional closure attempts were required in 22.2% of defects. With a median follow-up period of 5.5 months, overall defect closure success rate was 66.1% (55.0% fistulae vs. 79.6% leaks, p = 0.007). There were four mortalities from causes unrelated to the FTGID. Only 14.9% of patients with FTGID underwent operative management. There were no complications related to endoscopic intervention and no patients required urgent surgical intervention. Conclusions: Over-the-scope clip management of FTGID represents a safe alternative to potentially morbid operative intervention. When strictly defining success as complete closure of all FTGID, endoscopy was successful in 64.4% of patients with only a small minority of patients ultimately requiring surgery.

AB - Background: Endoscopic management of full-thickness gastrointestinal tract defects (FTGID) has become an attractive management strategy, as it avoids the morbidity of surgery. We have previously described the short-term outcomes of over-the-scope clip management of 22 patients with non-acute FTGID. This study updates our prior findings with a larger sample size and longer follow-up period. Methods: A retrospective analysis of prospectively collected data was conducted. All patients undergoing over-the-scope clip management of FTGID between 2013 and 2019 were identified. Acute perforations immediately managed and FTGID requiring endoscopic suturing were excluded. Patient demographics, endoscopic adjunct therapies, number of endoscopic interventions, and need for operative management were evaluated. Success was strictly defined as complete FTGID closure. Results: We identified 92 patients with 117 FTGID (65 fistulae and 52 leaks); 27.2% had more than one FTGID managed simultaneously. The OTSC device (Ovesco Endoscopy, Tubingen, Germany) was utilized in all cases. Additional closure attempts were required in 22.2% of defects. With a median follow-up period of 5.5 months, overall defect closure success rate was 66.1% (55.0% fistulae vs. 79.6% leaks, p = 0.007). There were four mortalities from causes unrelated to the FTGID. Only 14.9% of patients with FTGID underwent operative management. There were no complications related to endoscopic intervention and no patients required urgent surgical intervention. Conclusions: Over-the-scope clip management of FTGID represents a safe alternative to potentially morbid operative intervention. When strictly defining success as complete closure of all FTGID, endoscopy was successful in 64.4% of patients with only a small minority of patients ultimately requiring surgery.

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