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Efficacy and safety of over-the-scope clip: Including complications after endoscopic submucosal dissection

World Journal of Gastroenterology 2013年第18期19卷 2752-2760页

作者： Noriko Nishiyama Hirohito Mori Hideki Kobara Kazi Rafiq Shintarou Fujihara Mitsuyoshi Kobayashi Makoto Oryu Tsutomu Masaki Department of Gastroenterology and Neurology Faculty of Medicine Kagawa University Kagawa 761-0796 Japan Department of Pharmacology Faculty of Medicine Kagawa University Kagawa 761-0796 Japan

AIM: To retrospectively review the results of over-thescope clip (OTSC) use in our hospital and to examine the feasibility of using the OTSC to treat perforations after endoscopic submucosal dissection (ESD). METHODS: We enrolled 23 patients who presented with gastrointestinal (GI) bleeding, fistulae and perforations and were treated with OTSCs (Ovesco Endoscopy GmbH, Tuebingen, Germany) between November 2011 and September 2012. Maximum lesion size was defined as lesion diameter. The number of OTSCs to be used per patient was not decided until the lesion was completely closed. We used a twin grasper (Ovesco Endoscopy GmbH, Tuebingen, Germany) as a grasping device for all the patients. A 9 mm OTSC was chosen for use in the esophagus and colon, and a 10 mm device was used for the stomach, duodenum and rectum. The overall success rate and complications were evaluated, with a particular emphasis on patients who had undergone ESD due to adenocarcinoma. In technical successful cases we included not only complete closing by using OTSCs, but also partial closing where complete closure with OTSCs is almost difficult. In overall clinical successful cases we included only complete closing by using only OTSCs perfectly. All the OTSCs were placed by 2 experienced endoscopists. The sites closed after ESD included not only the perforation site but also all defective ulcers sites.RESULTS: A total of 23 patients [mean age 77 years (range 64-98 years)] underwent OTSC placement during the study period. The indications for OTSC placement were GI bleeding (n = 9), perforation (n = 10), fistula (n = 4) and the prevention of post-ESD duodenal artificial ulcer perforation (n = 1). One patient had a perforation caused by a glycerin enema, after which a fistula formed. Lesion closure using the OTSC alone was successful in 19 out of 23 patients, and overall success rate was 82.6%. A large lesion size (greater than 20 mm) and a delayed diagnosis (more than 1 wk) were the major contributing factors for the overall unsuccessful clinical cases

关键词： Over-the-scope clip Gastrointestinal bleed-ing Endoscopic submucosal dissection complications Gastrointestinal fistulae Gastrointestinal perforation

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Endoscopic variceal ligation caused massive bleeding due to laceration of an esophageal varicose vein with tissue glue emboli

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World Journal of Gastroenterology 2014年第42期20卷 15937-15940页

作者： Xiu-Qing Wei Hua-Ying Gu Zhi-E Wu Hui-Biao Miao Pei-Qi Wang Zhuo-Fu Wen Bin Wu Department of Gastroenterology the Third Affiliated Hospital of Sun Yat-Sen University

Endoscopic variceal obturation of gastric varices with tissue glue is considered the first choice for management of gastric varices, and is usually safe and effective. However, there is still a low incidence of complications and some are even fatal. Here, we present a case in which endoscopic variceal ligation caused laceration of the esophageal varicose vein with tissue glue emboli and massive bleeding after 3 mo. Cessation of bleeding was achieved via variceal sclerotherapy using a cap-fitted gastroscope. Methods of recognizing an esophageal varicose vein with tissue glue plug are discussed.

关键词： Gastroesophageal varices Variceal bleed-ing Lacera

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