Revista de Gastroenterología de México Revista de Gastroenterología de México
Rev Gastroenterol Mex 2017;82:266-7 - Vol. 82 Num.3 DOI: 10.1016/j.rgmxen.2016.11.003
Scientific letter
OTSC® system for the treatment of gastrointestinal perforations
Sistema de clip-OTSC® para el tratamiento de las perforaciones gastrointestinales
J.O. Alonso-Lárraga, , A. Hernández Guerrero, M.E. Ramírez-Solís, J.G. de la Mora Levy
Departamento de Endoscopia Gastrointestinal, Instituto Nacional de Cancerología, SSA, Mexico City, Mexico

Gastrointestinal perforations are rare, but severe, complications in endoscopic procedures and they have traditionally been treated through surgery. Endoscopic perforation treatment has been achieved through the use of clips. However, all clips have limitations with respect to the amount of tissue they can hold together, the number of clips that can be used, and their usefulness in inflamed tissue. The Over-The-Scope-Clip (OTSC)® system (Over-The-Scope-Clip®, Tübingen, Germany) is a recently developed device in which the clip is mounted on the endoscope. This clip grabs large quantities of tissue and closes the lesion until it heals.1,2 We present herein the cases of 5 patients with iatrogenic gastrointestinal perforation treated with the OTSC® system. Three of the patients were women and 2 were men and they were between 52-80 years of age. Diagnoses were cholangiocarcinoma (n=1), rectal cancer (n=1), and pancreatic tumor (n=3). The perforations resulted from colonoscopy (n=1) and endoscopic ultrasound (n=4) and were located at the rectosigmoid junction (n=1), gastric antrum (n=1), duodenal bulb (n=2), and the posterior wall of the stomach (n=1). They had a diameter of 5mm (n=1) and 10mm (n=4). An 11-mm type “t” OTSC® was placed in all the cases. Adequate OTSC® placement in the 4 patients with upper gastrointestinal perforation was confirmed through the instillation of contrast medium under fluoroscopic control. The patient with duodenal perforation underwent surgery due to the persistence of abdominal pain. During that surgery hermetic closure of the perforation was confirmed, but the OTSC® was removed and replaced with a double suture line. In the patient with the perforation at the rectosigmoid junction, tissue friability secondary to radiotherapy caused a small tear at one end of the OTSC® and closure was completed by the placement of a hemostatic clip. In addition, the patient presented with massive pneumoperitoneum that was managed through a percutaneous, 14-gauge needle puncture. The 5 patients began oral liquid diet 3 days after the perforation and were released from the hospital between 5-8 days after the incident.

The OTSC® system has been shown to be effective in the treatment of gastric, duodenal, and colonic perforations after endoscopy.2–4 Treatment was successful in our patients because perforation size was 10mm or smaller (Figures 1 and 2). Perforations up to 15mm can be closed using the OTSC® system1,5 and larger defects can be closed using 2 OTSC®s or one OTSC® and a hemostatic clip, as was the case in our patient with the perforation at the rectosigmoid junction.1,6

Figure 1.

5-mm perforation (arrow shows the length).

Figure 2.

Placed clip (arrows show the ends of the clip).

In a study that included 48 patients with perforation, the etiology in 75% (n=36) of the cases was iatrogenic. The most common location was the stomach (n=13, 27.1%), followed by the esophagus (n=10, 20.8%), duodenum (n=9, 18.8%), colon (n=8, 16.7%), rectum (n=4, 8.3%), and jejunum/ilium (n=4, 8.3%). The OTSC® was placed immediately after the perforation in 89.6% (n=43) of the cases. In 40 patients that were analyzed, technical success was achieved in 97.5% (n=39) and long-term clinical success in 90% (n=36).7

The OTSC® system is an alternative to the surgical treatment of iatrogenic gastrointestinal perforations. Complications and the mortality rate related to its use are unknown. Surgical treatment should be considered when the OTSC® fails, the perforation is recognized late (> 24h), or the patient shows signs of a systemic inflammatory response.8

Financial disclosure

No financial support was received in relation to this article.

Conflict of interest

The authors declare that there is no conflict of interest.

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Please cite this article as: Alonso-Lárraga JO, Hernández Guerrero A, Ramírez-Solís ME, de la Mora Levy JG. Sistema de clip-OTSC® para el tratamiento de las perforaciones gastrointestinales. Revista de Gastroenterología de México. 2017;82:266–267.

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Rev Gastroenterol Mex 2017;82:266-7 - Vol. 82 Num.3 DOI: 10.1016/j.rgmxen.2016.11.003