Over-the-Scope Clip in the Treatment of Gastrointestinal Leaks and Perforations
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While perforations, postoperative fistulas, and leaks have traditionally led to surgical or interventional radiology consultation formanagement, the introduction of the over-the-scope clip has allowed increased therapeutic possibilities for endoscopists. Whileprimarily limited to case reports and series, the over-the-scope clip successfully manages gastrointestinal bleeding, perforations, aswell as postoperative leaks and fistulas. Retrospective studies have demonstrated a relatively high success rate and a low complicationrate. Given the similarity to variceal banding equipment, the learning curve with the over-the-scope clip is rapid. However, given thehigher risk of procedures involving the use of the over-the-scope clip, it is essential to obtain the scope in a stable position and graspsufficient tissue with the cap using a grasping tool and/or suction. From our experience, while closure may be successful in lesionssized up to 3 cm, successful outcomes are obtained for lesions sized <1 cm. Ultimately, given the limited available data, prospectiverandomized trials are needed to better evaluate the utility of the over-the-scope clip in various clinical scenarios, including fistula andperforation management.
Abstract
While perforations, postoperative fistulas, and leaks have traditionally led to surgical or interventional radiology consultation formanagement, the introduction of the over-the-scope clip has allowed increased therapeutic possibilities for endoscopists. Whileprimarily limited to case reports and series, the over-the-scope clip successfully manages gastrointestinal bleeding, perforations, aswell as postoperative leaks and fistulas. Retrospective studies have demonstrated a relatively high success rate and a low complicationrate. Given the similarity to variceal banding equipment, the learning curve with the over-the-scope clip is rapid. However, given thehigher risk of procedures involving the use of the over-the-scope clip, it is essential to obtain the scope in a stable position and graspsufficient tissue with the cap using a grasping tool and/or suction. From our experience, while closure may be successful in lesionssized up to 3 cm, successful outcomes are obtained for lesions sized <1 cm. Ultimately, given the limited available data, prospectiverandomized trials are needed to better evaluate the utility of the over-the-scope clip in various clinical scenarios, including fistula andperforation management.
참고문헌 (47)
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