Colorectal postsurgical leaks and fistulas are severe complications that dramatically increase morbidity and mortality. The aim of this study was to evaluate the clinical impact of over-the-scope clip (OTSC) closure to seal the visceral wall in the management of acute and chronic colorectal postsurgical leaks and fistulas.
We reviewed our prospective series of acute and chronic colorectal postsurgical leaks and fistulas observed between April 2008 and September 2011 and treated by OTSC. Indications were all cases with an orifice <15 mm in maximum diameter with no extraluminal abscess and luminal stenosis.
Endoscopic OTSC closure was performed in 14 consecutive patients (mean defect = 9.1 mm in diameter) by means of 10.5- or 12-mm clips, depending on the wall defect diameter. In eight cases, the indication was an acute leak and in six cases a chronic leak, mainly after anterior rectal resection; two cases were complicated by a rectovaginal fistula and in two other cases by a colocutaneous fistula. OTSC treatment was used to complete endoscopic vacuum-assisted closure of a large defect in three cases. The overall success rate was 86 % (12/14): 87 % (7/8) in acute and 83 % (5/6) in chronic cases. No OTSC-related complications occurred. Further surgery was required in one case.
Endoscopic OTSC closure of colorectal postsurgical leaks and fistulas is a safe technique, with a high success rate in both acute and chronic cases, including rectovaginal and colocutaneous fistulas.
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Chambers WM, Mortensen NJ (2004) Postoperative leakage and abscess formation after colorectal surgery. Best Pract Res Clin Gastroenterol 18:865–880
Bruce J, Krukowski ZH, Al-Khairy G et al (2001) Systematic review of the definition and measurement of anastomotic leak after gastrointestinal surgery. Br J Surg 88:1157–1168
Weidenhagen R, Gruetzner KU, Wiecken T et al (2008) Endoscopic vacuum-assisted closure of anastomotic leakage following anterior resection of the rectum: a new method. Surg Endosc 22:1818–1825
Bonin EA, Baron TH (2010) Update on the indications and use of colonic stents. Curr Gastroenterol Rep 12:374–382
Trecca A, Gaj F, Gagliardi G (2008) Our experience with endoscopic repair of large colonoscopic perforations and review of the literature. Tech Coloproctol 12:315–321
Schurr MO, Hartmann C, Ho CN et al (2008) An over-the-scope clip (OTSC) system for closure of iatrogenic colon perforations: results of an experimental survival study in pigs. Endoscopy 40:584–588
Kirschniak A, Subotova N, Zieker D et al (2011) The over-the-scope clip (OTSC) for the treatment of gastrointestinal bleeding, perforations, and fistulas. Surg Endosc 25:2901–2905
Parodi A, Repici A, Pedroni A et al (2010) Endoscopic management of GI perforations with a new over-the-scope clip device (with videos). Gastrointest Endosc 72:881–886
Manta R, Manno M, Bertani H et al (2011) Endoscopic treatment of gastrointestinal fistulas using an over-the-scope clip (OTSC) device: case series from a tertiary referral center. Endoscopy 43:545–548
Raju GS, Gajula L (2004) Endoclips for GI endoscopy. Gastrointest Endosc 59:267–279
Raju GS, Kaltenbach T, Soetikno R (2007) Endoscopic mechanical hemostasis of GI arterial bleeding. Gastrointest Endosc 66:774–785
Voermans RP, Vergouwe F, Breedveld P et al (2011) Comparison of endoscopic closure modalities for standardized colonic perforations in a porcine colon model. Endoscopy 43:217–222
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Arezzo, A., Verra, M., Reddavid, R. et al. Efficacy of the over-the-scope clip (OTSC) for treatment of colorectal postsurgical leaks and fistulas. Surg Endosc 26, 3330–3333 (2012). https://doi.org/10.1007/s00464-012-2340-2
- Colorectal surgery
- Postoperative complications
- Anastomotic leak
- Endoscopic clips
- Over-the-scope clip