One hundred and one over-the-scope-clip applications forsevere gastrointestinal bleeding,leaks and fistulas

作     者：Edris Wedi Susana Gonzalez Detlev Menke Elena Kruse Kai Matthes Juergen Hochberger 

作者机构：Department of GastroenterologyNouvel Hôpital Civil and IHUStrasbourg University HospitalsF-67091 StrasbourgFrance Department of Medicine III-GastroenterologyInterventional EndoscopySt.Bernward Academic Teaching HospitalD-31134 HildesheimGermany Henry D Janowitz Division of GastroenterologyIcahn School of Medicine at Mount SinaiNew YorkNY 10023United States Department of AnesthesiologyPerioperative and Pain MedicineBoston Children’s HospitalHarvard Medical SchoolBostonMA 02115United States Section of Gastroenterology and GI EndoscopyInterdisciplinary Center for Digestive DiseasesStrasbourg University HospitalsNouvel Hôpital Civil and IHUF-67091 StrasbourgFrance 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2016年第22卷第5期

页      面：1844-1853页

核心收录：

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

基　　金：Supported by The“Endo-Verein Erlangen” a registered non-profit training organization Baiersdorf Germany 

主　　题：Over-the-scope-clip Endoscopic therapy Gastrointestinal bleeding Perforation Fistula 

摘      要：AIM: To investigate the efficacy and clinical outcome of patients treated with an over-the-scope-clip(OTSC) system for severe gastrointestinal hemorrhage, perforations and ***: From 02-2009 to 10-2012, 84 patients were treated with 101 OTSC clips. 41 patients(48.8%) presented with severe upper-gastrointestinal(GI) bleeding, 3(3.6%) patients with lower-GI bleeding, 7 patients(8.3%) underwent perforation closure, 18 patients(21.4%) had prevention of secondary perforation, 12 patients(14.3%) had control of secondary bleeding after endoscopic mucosal resection or endoscopic submucosal dissection(ESD) and 3 patients(3.6%) had an intervention on a chronic fistula. RESULTS: In 78/84 patients(92.8%), primary treatment with the OTSC was technically successful. Clinical primary success was achieved in 75/84 patients(89.28%). The overall mortality in the study patients was 11/84(13.1%) and was seen in patients with life threatning upper GI hemorrhage. There was no mortality in any other treatment group. In detail OTSC application lead to a clinical success in 35/41(85.36%) patients with upper GI bleeding and in 3/3 patients with lower GI bleeding. Technical success of perforation closure was 100% while clinical success was seen in 4/7 cases(57.14%) due to attendant circumstances unrelated to the OTSC. Technical and clinic success was achieved in 18/18(100%) patients for the prevention of bleeding or perforation after endoscopic mucosal resection and ESD and in 3/3 cases of fistula closure. Two application-related complications were seen(2%).CONCLUSION: This largest single center experience published so far confirms the value of the OTSC for GI emergencies and complications. Further clinical experience will help to identify optimal indications for its targeted and prophylactic use.