BACKGROUND Secure transluminal closure remains a fundamental barrier to endoscopic surgery.It has been reported that through-the-scope clips were used to secure the incision of the gallbladder during natural orifice t...BACKGROUND Secure transluminal closure remains a fundamental barrier to endoscopic surgery.It has been reported that through-the-scope clips were used to secure the incision of the gallbladder during natural orifice transluminal endoscopic cholecystolithotomy and were left in the body post-operation.The over-the-scope clip(OTSC)is favored for its rapid deployment and strong anchoring capabilities.Nevertheless,OTSCs are difficult to remove once implanted.The Senscure Biotechnology in China has developed a detachable over-the-scope clip(D-OTSC)for this purpose.Here,we utilized the D-OTSC to successfully close a full-thickness sigmoid defect exceeding 1 cm in diameter.Subsequently,the clip was completely removed postoperatively,yielding favorable clinical outcomes.CASE SUMMARY We present the case of a 51-year-old female patient who underwent natural orifice transluminal endoscopic cholecystolithotomy.The sigmoid incision was closed using a D-OTSC.Postoperative recovery was uneventful,with no abdominal infection or bleeding.The D-OTSC was subsequently removed via enteroscopy in the outpatient department one month later.CONCLUSION The utilization of D-OTSC presents a viable option for closing colonic mucosal incisions ranging from 1 cm to 2 cm.展开更多
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:...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. The location of the unsuccessful lesion was in the stomach. The median operation time in the successful cases was 18 min, and the average observation time was 67 d. During the observation period, none of the patients experienced any complications associated with OTSC placement. In addition, we successfully used the OTSC to close the perforation site after ESD in 6 patients. This was a single-center, retrospective study with a small sample size. CONCLUSION: The OTSC is effective for treating GI bleeding, fistulae as well as perforations, and the OTSC technique proofed effective treatment for perforation after ESD.展开更多
Endoscopic management of leakages and perforations of the upper gastrointestinal tract has gained great importance as it avoids the morbidity and mortality of surgical intervention.In the past years,covered selfexpand...Endoscopic management of leakages and perforations of the upper gastrointestinal tract has gained great importance as it avoids the morbidity and mortality of surgical intervention.In the past years,covered selfexpanding metal stents were the mainstay of endoscopic therapy.However,two new techniques are now available that enlarge the possibilities of defect closure:endoscopic vacuum therapy(EVT),and over-the-scope clip(OTSC).EVT is performed by mounting a polyurethane sponge on a gastric tube and placing it into the leakage.Continuous suction is applied via the tube resulting in effective drainage of the cavity and the induction of wound healing,comparable to the application of vacuum therapy in cutaneous wounds.The system is changed every 3-5 d.The overall success rate of EVT in the literature ranges from 84%to 100%,with a mean of 90%;only few complications have been reported.OTSCs are loaded on a transparent cap which is mounted on the tip of a standard endoscope.By bringing the edges of the perforation into the cap,by suction or by dedicated devices,such as anchor or twin grasper,the OTSC can be placed to close the perforation.For acute endoscopy associated perforations,the mean success rate is 90%(range:70%-100%).For other types of perforations(postoperative,other chronic leaks and fistulas)success rates are somewhat lower(68%,and59%,respectively).Only few complications have been reported.Although first reports are promising,further studies are needed to define the exact role of EVT and OTSC in treatment algorithms of upper gastrointestinal perforations.展开更多
BACKGROUND The over-the-scope clip(OTSC)system has been increasingly utilized as a nonsurgical option to endoscopically manage refractory gastrointestinal(GI)hemorrhage,perforations/luminal defects and fistulas.Limite...BACKGROUND The over-the-scope clip(OTSC)system has been increasingly utilized as a nonsurgical option to endoscopically manage refractory gastrointestinal(GI)hemorrhage,perforations/luminal defects and fistulas.Limited data exist evaluating the efficacy and safety of OTSC.AIM To determine the clinical success and adverse event(AE)rates of OTSC across all GI indications.METHODS A PubMed search was conducted for eligible articles describing the application of the OTSC system for any indication in the GI tract.Any article or case series reporting data for less than 5 total patients was excluded.The primary outcome was the rate of clinical success.Secondary outcomes included:Technical success rate,OTSC-related AE rate and requirement for surgical intervention despite-OTSC placement.Pooled rates(per-indication and overall)were calculated as the number of patients with the event of interest divided by the total number of patients.RESULTS A total of 85 articles met our inclusion criteria(n=3025 patients).OTSC was successfully deployed in 94.4%of patients(n=2856/3025).The overall rate of clinical success(all indications)was 78.4%(n=2371/3025).Per-indication clinical success rates were as follows:(1)86.0%(1120/1303)for GI hemorrhage;(2)85.3%(399/468)for perforation;(3)55.8%(347/622)for fistulae;(4)72.6%(284/391)for anastomotic leaks;(5)92.8%(205/221)for defect closure following endoscopic resection(e.g.,following endoscopic mucosal resection or endoscopic submucosal dissection);and(6)80.0%(16/20)for stent fixation.AE’s related to the deployment of OTSC were only reported in 64 of 85 studies(n=1942 patients),with an overall AE rate of 2.1%(n=40/1942).Salvage surgical intervention was required in 4.7%of patients(n=143/3025).CONCLUSION This systematic review demonstrates that the OTSC system is a safe and effective endoscopic therapy to manage GI hemorrhage,perforations,anastomotic leaks,defects created by endoscopic resections and for stent fixation.Clinical success in fistula management appears limited.Further studies,including randomized controlled trials comparing OTSC with conventional and/or surgical therapies,are needed to determine which indication(s)are the most effective for its use.展开更多
AIM To evaluate rebleeding, primary failure(PF) and mortality of patients in whom over-the-scope clips(OTSCs) were used as first-line and second-line endoscopic treatment(FLET, SLET) of upper and lower gastrointestina...AIM To evaluate rebleeding, primary failure(PF) and mortality of patients in whom over-the-scope clips(OTSCs) were used as first-line and second-line endoscopic treatment(FLET, SLET) of upper and lower gastrointestinal bleeding(UGIB, LGIB).METHODS A retrospective analysis of a prospectively collected database identified all patients with UGIB and LGIB in a tertiary endoscopic referral center of the University of Freiburg, Germany, from 04-2012 to 05-2016(n= 93) who underwent FLET and SLET with OTSCs. The complete Rockall risk scores were calculated from patients with UGIB. The scores were categorized as < or ≥ 7 and were compared with the original Rockall data. Differences between FLET and SLET were calculated. Univariate and multivariate analysis were performed to evaluate the factors that influenced rebleeding after OTSC placement.RESULTS Primary hemostasis and clinical success of bleeding lesions(without rebleeding) was achieved in 88/100(88%) and 78/100(78%), respectively. PF was significantly lower when OTSCs were applied as FLET compared to SLET(4.9% vs 23%, P = 0.008). In multivariate analysis, patients who had OTSC placement as SLET had a significantly higher rebleeding risk compared to those who had FLET(OR 5.3; P = 0.008). Patients with Rockall risk scores ≥ 7 had a significantly higher in-hospital mortality compared to those with scores < 7(35% vs 10%, P = 0.034). No significant differences were observed in patients with scores < or ≥ 7 in rebleeding and rebleeding-associated mortality.CONCLUSION Our data show for the first time that FLET with OTSC might be the best predictor to successfully prevent rebleeding of gastrointestinal bleeding compared to SLET. The type of treatment determines the success of primary hemostasis or primary failure.展开更多
BACKGROUND Endoscopic submucosal dissection to treat mucosal and submucosal lesions sometimes results in low rates of microscopically margin-negative(R0)resection.Endoscopic full-thickness resection(EFTR)has a high R0...BACKGROUND Endoscopic submucosal dissection to treat mucosal and submucosal lesions sometimes results in low rates of microscopically margin-negative(R0)resection.Endoscopic full-thickness resection(EFTR)has a high R0 resection rate and allows for the definitive diagnosis and treatment of selected mucosal and submucosal lesions that are not suitable for conventional resection techniques.AIM To evaluate the efficacy and safety of EFTR using an over-the-scope clip(OTSC).METHODS This prospective,single-center,non-randomized clinical trial was conducted at the endoscopy center of Shengjing Hospital of China Medical University.The study included patients aged 18-70 years who had gastric or colorectal submucosal tumors(SMTs)(≤20 mm in diameter)originating from the muscularis propria based on endoscopic ultrasound(EUS)and patients who had early-stage gastric or colorectal cancer(≤20 mm in diameter)based on EUS and computed tomography.All lesions were treated by EFTR combined with an OTSC for wound closure between November 2014 and October 2016.We analyzed patient demographics,lesion features,histopathological diagnoses,R0 resection(negative margins)status,adverse events,and follow-up results.RESULTS A total of 68 patients(17 men and 51 women)with an average age of 52.0±10.5 years(32-71 years)were enrolled in this study,which included 66 gastric or colorectal SMTs and 2 early-stage colorectal cancers.The mean tumor diameter was 12.6±4.3 mm.The EFTR procedure was successful in all cases.The mean EFTR procedure time was 39.6±38.0 min.The mean OTSC defect closure time was 5.0±3.8 min,and the success rate of closure for defects was 100%.Histologically complete resection(R0)was achieved in 67(98.5%)patients.Procedure-related adverse events were observed in 11(16.2%)patients.The average post-procedure length of follow-up was 48.2±15.7 mo.There was no recurrence during follow-up.CONCLUSION EFTR combined with an OTSC is an effective and safe technique for the removal of select subepithelial and epithelial lesions that are not amenable to conventional endoscopic resection techniques.展开更多
An ileal pouch fistula is an uncommon complication after an ileal pouch anal anastomosis. Most patients who suffer from an ileal pouch fistula will need surgical intervention. However, the surgery can be invasive and ...An ileal pouch fistula is an uncommon complication after an ileal pouch anal anastomosis. Most patients who suffer from an ileal pouch fistula will need surgical intervention. However, the surgery can be invasive and has a high risk compared to endoscopic treatment. The over-the-scope clip(OTSC) system was initially developed for hemostasis and leakage closure in the gastrointestinal tract during flexible endoscopy. There have been many successes in using this approach to apply perforations to the upper gastrointestinal tract. However, this approach has not been used for ileal pouch fistulas until currently. In this report, we describe one patient who suffered a leak from the tip of the "J" pouch and was successfully treated with endoscopic closure via the OTSC system. A 26-year-old male patient had an intestinal fistula at the tip of the "J" pouch after an ileal pouch anal anastomosis procedure. He received endoscopic treatment via OTSC under intravenous anesthesia, and the leak was closed successfully. Endoscopic closure of a pouch fistula could be a simpler alternative to surgery and could help avoid surgeryrelated complications.展开更多
This paper reports our experience with a new overthe-scope clip in the setting of recurrent bleeding and oesophageal fistula. We treated five patients with the over-the-scope Padlock Clip?. It is a nitinol ring, with ...This paper reports our experience with a new overthe-scope clip in the setting of recurrent bleeding and oesophageal fistula. We treated five patients with the over-the-scope Padlock Clip?. It is a nitinol ring, with six inner needles preassembled on an applicator cap, thumb press displaced by the Lock-It? delivery system. The trigger wire is located alongside the shaft of the endoscope, and does not require the working channel. Three patients had recurrent bleeding lesions(bleeding rectal ulcer, post polypectomy delayed bleeding and duodenal Dieulafoy's lesion) and two patients had a persistent respiratory-esophageal fistula. In all patients a previous endoscopic attempt with standard techniques had been useless. All procedures were conducted under conscious sedation but for one patient that required general anaesthesia due to multiple comorbidities. We used one Padlock Clip? for each patient in a single session. Simple suction was enough in all of our patients to obtain tissue adhesion to the instrument tip. A remarkably short application time was recorded for all cases(mean duration of the procedure: 8 min). We obtained technical and immediate clinical success for every patient. No major immediate, early or late(within 24 h, 7 d or 4 wk) adverse events were observed, over follow-up durations lasting a mean of 109.4 d. One patient, treated for duodenal bulb bleeding from a Dieulafoy's lesion, developed signs of mild pancreatitis 24 h after the procedure. The new over-the-scope Padlock Clip? seems to be simple to use and effective in different clinical settings, particularly in "difficult" scenarios, like recurrent bleeding and respiratory-oesophageal fistulas.展开更多
BACKGROUND Endoscopic resection of duodenal subepithelial lesions(SELs)is a difficult procedure with a high risk of perforation.At present,dealing with perforation after endoscopic resection of duodenal SELs is still ...BACKGROUND Endoscopic resection of duodenal subepithelial lesions(SELs)is a difficult procedure with a high risk of perforation.At present,dealing with perforation after endoscopic resection of duodenal SELs is still considered a great challenge.AIM To evaluate the effectiveness and safety of an over-the-scope clip(OTSC)in the treatment of perforation post-endoscopic resection of duodenal SELs.METHODS From May 2015 to November 2019,18 patients with perforation following endoscopic resection of duodenal SELs were treated with OTSCs.Data comprising the rate of complete resection,closure of intraprocedural perforation,delayed bleeding,delayed perforation,and postoperative infection were extracted.RESULTS The rate of complete removal of duodenal SELs and successful closure of the perforation was 100%.The median perforation size was 1 cm in diameter.Seventeen patients had minor intraoperative bleeding,while the remaining 1 patient had considerable amount of bleeding during the procedure.Seven patients had postoperative abdominal infections,of which 1 patient developed an abscess in the right iliac fossa and another patient developed septic shock.All 18 patients recovered and were discharged.No delayed bleeding or perforation was reported.The mean time taken to resume normal diet after the procedure was 6.5 d.The mean postoperative hospital stay was 9.5 d.No residual or recurrent lesions were detected during the follow-up period(15-66 mo).CONCLUSION Closing a perforation after endoscopic resection of duodenal SELs with OTSCs seems to be an effective and reasonably safe therapeutic method.展开更多
Over-the-scope clip(OTSC) system is becoming a new reliable technique which is available for the endoscopic closure of fistulas, bleeding, perforations and so on. We describe the case of a patient with a nonhealing ga...Over-the-scope clip(OTSC) system is becoming a new reliable technique which is available for the endoscopic closure of fistulas, bleeding, perforations and so on. We describe the case of a patient with a nonhealing gastrocutaneous fistula after esophagectomy for esophageal squamous cell carcinoma which was successfully closed using an OTSC system. This is the first report of the use of OTSC to treat a nonhealing gastrocutaneous fistula successfully after esophagectomy. We believe our experience will give such patients an ideal way to cure the fistula without suffering too much and also explore new application of OTSC.展开更多
Non-variceal upper gastrointestinal(GI)bleeding is a significant cause of morbidity and mortality.Traditionally,through-the-scope(TTS)clips,thermal therapy,and injection therapies are used to treat GI bleeding.In this...Non-variceal upper gastrointestinal(GI)bleeding is a significant cause of morbidity and mortality.Traditionally,through-the-scope(TTS)clips,thermal therapy,and injection therapies are used to treat GI bleeding.In this review,we provide an overview of novel endoscopic treatments that can be used to achieve hemostasis.Specifically,we discuss the efficacy and applicability of over-thescope clips,hemostatic agents,TTS doppler ultrasound,and endoscopic ultrasound,each of which offer an effective method of reducing rates of GI rebleeding.展开更多
Gastrointestinal leaks and fistulae are serious, potentially life threateningconditions that may occur with a wide variety of clinical presentations. Leaks aremostly related to post-operative anastomotic defects and a...Gastrointestinal leaks and fistulae are serious, potentially life threateningconditions that may occur with a wide variety of clinical presentations. Leaks aremostly related to post-operative anastomotic defects and are responsible for animportant share of surgical morbidity and mortality. Chronic leaks and longstanding post-operative collections may evolve in a fistula between twoepithelialized structures. Endoscopy has earned a pivotal role in the managementof gastrointestinal defects both as first line and as rescue treatment. Endotherapyis a minimally invasive, effective approach with lower morbidity and mortalitycompared to revisional surgery. Clips and luminal stents are the pioneer ofgastrointestinal (GI) defect endotherapy, whereas innovative endoscopic closuredevices and techniques, such as endoscopic internal drainage, suturing systemand vacuum therapy, has broadened the indications of endoscopy for themanagement of GI wall defect. Although several endoscopic options are currentlyused, a standardized evidence-based algorithm for management of GI defect isnot available. Successful management of gastrointestinal leaks and fistulaerequires a tailored and multidisciplinary approach based on clinical presentation,defect features (size, location and onset time), local expertise and the availabilityof devices. In this review, we analyze different endoscopic approaches, which weselected on the basis of the available literature and our own experience. Then, weevaluate the overall efficacy and procedural-specific strengths and weaknesses ofeach approach.展开更多
Conventional endoscopic resection techniques such as endoscopic mucosal resection or endoscopic submucosal dissection are powerful tools for treatment of gastrointestinal neoplasms. However,those techniques are restri...Conventional endoscopic resection techniques such as endoscopic mucosal resection or endoscopic submucosal dissection are powerful tools for treatment of gastrointestinal neoplasms. However,those techniques are restricted to superficial layers of the gastrointestinal wall. Endoscopic full-thickness resection(EFTR) is an evolving technique,which is just about to enter clinical routine. It is not only a powerful tool for diagnostic tissue acquisition but also has the potential to spare surgical therapy in selected patients. This review will give an overview about current EFTR techniques and devices.展开更多
Duodenal endoscopic resection is the most difficult type of endoscopic treatment in the gastrointestinal tract(GI) and is technically challenging because of anatomical specificities. In addition to these technical dif...Duodenal endoscopic resection is the most difficult type of endoscopic treatment in the gastrointestinal tract(GI) and is technically challenging because of anatomical specificities. In addition to these technical difficulties, this procedure is associated with a significantly higher rate of complication than endoscopic treatment in other parts of the GI tract. Postoperative delayed perforation and bleeding are hazardous complications, and emergency surgical intervention is sometimes required. Therefore, it is urgently necessary to establish a management protocol for preventing serious complications. For instance, the prophylactic closure of large mucosal defects after endoscopic resection may reduce the risk of hazardous complications. However, the size of mucosal defects after endoscopic submucosal dissection(ESD) is relatively large compared with the size after endoscopic mucosal resection, making it impossible to achieve complete closure using only conventional clips. The over-the-scope clip and polyglycolic acid sheets with fibrin gel make it possible to close large mucosal defects after duodenal ESD. In addition to the combination of laparoscopic surgery and endoscopic resection, endoscopic full-thickness resection holds therapeutic potential for difficult duodenal lesions and may overcome the disadvantages of endoscopic resection in the near future. This review aims to summarize the complications and closure techniques of large mucosal defects and to highlight some directions for management after duodenal endoscopic treatment.展开更多
Advances in endoscopic and surgical techniques have increased the frequency and complexity of these procedures and associated complications such as gastrointestinal perforation. With the advancements in the field of g...Advances in endoscopic and surgical techniques have increased the frequency and complexity of these procedures and associated complications such as gastrointestinal perforation. With the advancements in the field of gastroenterology, the promising use of an over the scope clips(OTSC) has fulfilled the unmet need for a reliable endoscopic devise in approximation of gastrointestinal perforation. This novel approach has raised the level of confidence in endoscopist in dealing with this serious complication during endoscopy. Here we have shared our experience with OTSC to evaluate its efficacy and safety in managing iatrogenic gastrointestinal perforations during endoscopy.展开更多
To demonstrate the clinical outcomes of a multicenter experience and to suggest guidelines for choosing a suction method.METHODSThis retrospective study at 5 medical centers involved 58 consecutive patients undergoing...To demonstrate the clinical outcomes of a multicenter experience and to suggest guidelines for choosing a suction method.METHODSThis retrospective study at 5 medical centers involved 58 consecutive patients undergoing over-the-scope clips(OTSCs)placement.The overall rates of technical success(TSR),clinical success(CSR),complications,and procedure time were analyzed as major outcomes.Subsequently,56 patients,excluding two cases that used the Anchor device,were divided into two groups:14 cases of simple suction(SS-group)and 42 cases using the Twin Grasper(TG-group).Secondary evaluation was performed to clarify the predictors of OTSC success.RESULTSThe TSR,CSR,complication rate,and median procedure time were 89.7%,84.5%,1.8%,and 8(range 1-36)min,respectively,demonstrating good outcomes.However,significant differences were observed between the two groups in terms of the mean procedure time(5.9 min vs 14.1 min).The CSR of the SS-and TG-groups among cases with a maximum defect size≤10 mm and immediate or acute refractory bleeding was 100%,which suggests that SS is a better method than TG in terms of time efficacy.The CSR in the SS-group(78.6%),despite the technical success of the SS method(TSR,100%),tended to decrease due to delayed leakage compared to that in the TG-group(TSR,CSR;88.1%),indicating that TG may be desirable for leaks and fistulae with defects of the entire layer.CONCLUSIONOTSC system is a safe and effective therapeutic option for gastrointestinal defects.Individualized selection of the suction method based on particular clinical conditions may contribute to the improvement of OTSC success.展开更多
The present armamentarium of endoscopic hemostatic therapy for non-variceal upper gastrointestinal hemorrhage includes injection,electrocautery and clips.There are newer endoscopic options such as hemostatic sprays,en...The present armamentarium of endoscopic hemostatic therapy for non-variceal upper gastrointestinal hemorrhage includes injection,electrocautery and clips.There are newer endoscopic options such as hemostatic sprays,endoscopic suturing and modifications of current options including coagulation forceps and over-the-scope clips.Peptic hemorrhage is the most prevalent type of nonvariceal upper gastrointestinal hemorrhage and traditional endoscopic interventions have demonstrated significant hemostasis success.However,the hemostatic success rate is less for other entities such as Dieulafoy’s lesions and bleeding from malignant lesions.Novel innovations such as endoscopic submucosal dissection and peroral endoscopic myotomy has spawned a need for dependable hemostasis.Gastric antral vascular ectasias are associated with chronic gastrointestinal bleeding and usually treated by standard argon plasma coagulation (APC),but newer modalities such as radiofrequency ablation,banding,cryotherapy and hybrid APC have been utilized as well.We will opine on whether the newer hemostatic modalities have generated success when traditional modalities fail and should any of these modalities be routinely available in the endoscopic toolbox.展开更多
BACKGROUND Radiofrequency ablation(RFA)and microwave ablation(MWA)represent the standard of care for patients with early hepatocellular carcinoma(HCC)who are unfit for surgery.The incidence of reported adverse events ...BACKGROUND Radiofrequency ablation(RFA)and microwave ablation(MWA)represent the standard of care for patients with early hepatocellular carcinoma(HCC)who are unfit for surgery.The incidence of reported adverse events is low,ranging from 2.4%to 13.1%for RFA and from 2.6%to 7.5%for MWA.Gastrointestinal tract(GIT)injury is even more infrequent(0.11%),but usually requires surgery with an unfavourable prognosis.Due to its low incidence and the retrospective nature of the studies,the literature reporting this feared complication is heterogeneous and in many cases lacks information on tumour characteristics,comorbidities and treatment approaches.CASE SUMMARY A 77-year-old man who had undergone extended right hepatectomy for HCC was diagnosed with early disease recurrence with a small nodule compatible with HCC in the Sg4b segment of the liver with a subcapsular location.He was treated with percutaneous RFA and a few week later he was urgently admitted to the Surgery ward for abdominal pain and fever.A subcutaneous abscess was diagnosed and treated by percutaneous drainage.A fistulous tract was then documented by the passage of contrast material from the gastric antrum to the abdominal wall.The oesophagogastroduodenoscopy confirmed a circular wall defect at the lesser curvature of gastric antrum, leading directly to the purulentabdominal collection. An over-the-scope clip (OTSC) was used to successfullyclose the defectCONCLUSIONThis is the first reported case of RFA-related GIT injury to have been successfullytreated with an OTSC, which highlights the role of this endoscopic treatment forthe management of this complication.展开更多
BACKGROUNDGiven the high incidence of esophageal cancer in China,an increasing number ofpatients there are undergoing endoscopic mucosal dissection(ESD).Although the5-year survival rate after ESD can exceed 95%,esopha...BACKGROUNDGiven the high incidence of esophageal cancer in China,an increasing number ofpatients there are undergoing endoscopic mucosal dissection(ESD).Although the5-year survival rate after ESD can exceed 95%,esophageal stricture,the mostcommon and serious postoperative complication,affects the long-term prognosisof patients and the quality of life.Autologous mucosal grafts have proven to besuccessful in preventing stricture after ESD for early esophageal cancer.AIMTo examine the viability of acellular dermal matrix(ADM)as an alternative to autologous mucosa for the prevention of stricture after ESD.METHODSThis is a prospective,single-center,controlled study.Consecutive patients who underwent ESD surgery and werewilling to undergo autologous mucosal transplantation were recruited between January 1 and December 31,2017.Consecutive patients who underwent ESD surgery and were willing to undergo ADM transplantation wererecruited between January 1 to December 31,2019.A final three-year follow-up of patients who receivedtransplants was conducted.RESULTSBased on the current incidence of esophageal stricture,the sample size required for both the autologous mucosalgraft group and the ADM group was calculated to be 160 cases.Due to various factors,a total of 20 patients withautologous mucosal grafts and 25 with ADM grafts were recruited.Based on the inclusion exclusion andwithdrawal criteria,9 patients ultimately received autologous mucosal grafts and completed the follow-up,while11 patients received ADM grafts and completed the follow-up.Finally,there were 2 cases of stenosis in theautologous mucosal transplantation group with a stenosis rate of 22.22%and 2 cases of stenosis in the ADMtransplantation group with a stenosis rate of 18.18%,with no significant difference noted between the groups(P=0.94).CONCLUSIONIn this prospective,single-center,controlled trial,we compared the effectiveness of autologous mucosatransplantation and ADM for the prevention of esophageal stricture.Due to certain condition limitations,we wereunable to recruit sufficient subjects meeting our target requirements.However,we implemented strict inclusion,exclusion,and withdrawal criteria and successfully completed three years of follow-up,resulting in valuableclinical insights.Based on our findings,we hypothesize that ADM may be similarly effective to autologousmucosal transplantation in the prevention of esophageal stricture,offering a comparable and alternative approach.This study provides a new therapeutic idea and direction for the prevention of esophageal stricture.展开更多
基金Supported by Natural Science Foundation of Fujian Province,China,No.2021J01545.
文摘BACKGROUND Secure transluminal closure remains a fundamental barrier to endoscopic surgery.It has been reported that through-the-scope clips were used to secure the incision of the gallbladder during natural orifice transluminal endoscopic cholecystolithotomy and were left in the body post-operation.The over-the-scope clip(OTSC)is favored for its rapid deployment and strong anchoring capabilities.Nevertheless,OTSCs are difficult to remove once implanted.The Senscure Biotechnology in China has developed a detachable over-the-scope clip(D-OTSC)for this purpose.Here,we utilized the D-OTSC to successfully close a full-thickness sigmoid defect exceeding 1 cm in diameter.Subsequently,the clip was completely removed postoperatively,yielding favorable clinical outcomes.CASE SUMMARY We present the case of a 51-year-old female patient who underwent natural orifice transluminal endoscopic cholecystolithotomy.The sigmoid incision was closed using a D-OTSC.Postoperative recovery was uneventful,with no abdominal infection or bleeding.The D-OTSC was subsequently removed via enteroscopy in the outpatient department one month later.CONCLUSION The utilization of D-OTSC presents a viable option for closing colonic mucosal incisions ranging from 1 cm to 2 cm.
文摘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. The location of the unsuccessful lesion was in the stomach. The median operation time in the successful cases was 18 min, and the average observation time was 67 d. During the observation period, none of the patients experienced any complications associated with OTSC placement. In addition, we successfully used the OTSC to close the perforation site after ESD in 6 patients. This was a single-center, retrospective study with a small sample size. CONCLUSION: The OTSC is effective for treating GI bleeding, fistulae as well as perforations, and the OTSC technique proofed effective treatment for perforation after ESD.
文摘Endoscopic management of leakages and perforations of the upper gastrointestinal tract has gained great importance as it avoids the morbidity and mortality of surgical intervention.In the past years,covered selfexpanding metal stents were the mainstay of endoscopic therapy.However,two new techniques are now available that enlarge the possibilities of defect closure:endoscopic vacuum therapy(EVT),and over-the-scope clip(OTSC).EVT is performed by mounting a polyurethane sponge on a gastric tube and placing it into the leakage.Continuous suction is applied via the tube resulting in effective drainage of the cavity and the induction of wound healing,comparable to the application of vacuum therapy in cutaneous wounds.The system is changed every 3-5 d.The overall success rate of EVT in the literature ranges from 84%to 100%,with a mean of 90%;only few complications have been reported.OTSCs are loaded on a transparent cap which is mounted on the tip of a standard endoscope.By bringing the edges of the perforation into the cap,by suction or by dedicated devices,such as anchor or twin grasper,the OTSC can be placed to close the perforation.For acute endoscopy associated perforations,the mean success rate is 90%(range:70%-100%).For other types of perforations(postoperative,other chronic leaks and fistulas)success rates are somewhat lower(68%,and59%,respectively).Only few complications have been reported.Although first reports are promising,further studies are needed to define the exact role of EVT and OTSC in treatment algorithms of upper gastrointestinal perforations.
文摘BACKGROUND The over-the-scope clip(OTSC)system has been increasingly utilized as a nonsurgical option to endoscopically manage refractory gastrointestinal(GI)hemorrhage,perforations/luminal defects and fistulas.Limited data exist evaluating the efficacy and safety of OTSC.AIM To determine the clinical success and adverse event(AE)rates of OTSC across all GI indications.METHODS A PubMed search was conducted for eligible articles describing the application of the OTSC system for any indication in the GI tract.Any article or case series reporting data for less than 5 total patients was excluded.The primary outcome was the rate of clinical success.Secondary outcomes included:Technical success rate,OTSC-related AE rate and requirement for surgical intervention despite-OTSC placement.Pooled rates(per-indication and overall)were calculated as the number of patients with the event of interest divided by the total number of patients.RESULTS A total of 85 articles met our inclusion criteria(n=3025 patients).OTSC was successfully deployed in 94.4%of patients(n=2856/3025).The overall rate of clinical success(all indications)was 78.4%(n=2371/3025).Per-indication clinical success rates were as follows:(1)86.0%(1120/1303)for GI hemorrhage;(2)85.3%(399/468)for perforation;(3)55.8%(347/622)for fistulae;(4)72.6%(284/391)for anastomotic leaks;(5)92.8%(205/221)for defect closure following endoscopic resection(e.g.,following endoscopic mucosal resection or endoscopic submucosal dissection);and(6)80.0%(16/20)for stent fixation.AE’s related to the deployment of OTSC were only reported in 64 of 85 studies(n=1942 patients),with an overall AE rate of 2.1%(n=40/1942).Salvage surgical intervention was required in 4.7%of patients(n=143/3025).CONCLUSION This systematic review demonstrates that the OTSC system is a safe and effective endoscopic therapy to manage GI hemorrhage,perforations,anastomotic leaks,defects created by endoscopic resections and for stent fixation.Clinical success in fistula management appears limited.Further studies,including randomized controlled trials comparing OTSC with conventional and/or surgical therapies,are needed to determine which indication(s)are the most effective for its use.
文摘AIM To evaluate rebleeding, primary failure(PF) and mortality of patients in whom over-the-scope clips(OTSCs) were used as first-line and second-line endoscopic treatment(FLET, SLET) of upper and lower gastrointestinal bleeding(UGIB, LGIB).METHODS A retrospective analysis of a prospectively collected database identified all patients with UGIB and LGIB in a tertiary endoscopic referral center of the University of Freiburg, Germany, from 04-2012 to 05-2016(n= 93) who underwent FLET and SLET with OTSCs. The complete Rockall risk scores were calculated from patients with UGIB. The scores were categorized as < or ≥ 7 and were compared with the original Rockall data. Differences between FLET and SLET were calculated. Univariate and multivariate analysis were performed to evaluate the factors that influenced rebleeding after OTSC placement.RESULTS Primary hemostasis and clinical success of bleeding lesions(without rebleeding) was achieved in 88/100(88%) and 78/100(78%), respectively. PF was significantly lower when OTSCs were applied as FLET compared to SLET(4.9% vs 23%, P = 0.008). In multivariate analysis, patients who had OTSC placement as SLET had a significantly higher rebleeding risk compared to those who had FLET(OR 5.3; P = 0.008). Patients with Rockall risk scores ≥ 7 had a significantly higher in-hospital mortality compared to those with scores < 7(35% vs 10%, P = 0.034). No significant differences were observed in patients with scores < or ≥ 7 in rebleeding and rebleeding-associated mortality.CONCLUSION Our data show for the first time that FLET with OTSC might be the best predictor to successfully prevent rebleeding of gastrointestinal bleeding compared to SLET. The type of treatment determines the success of primary hemostasis or primary failure.
基金National Natural Science Foundation of China,No.81900601Innovative Talent Support Program of Liaoning Province,No.LR2019073Outstanding Scientific Fund of Shengjing Hospital,No.201701 and No.201702.
文摘BACKGROUND Endoscopic submucosal dissection to treat mucosal and submucosal lesions sometimes results in low rates of microscopically margin-negative(R0)resection.Endoscopic full-thickness resection(EFTR)has a high R0 resection rate and allows for the definitive diagnosis and treatment of selected mucosal and submucosal lesions that are not suitable for conventional resection techniques.AIM To evaluate the efficacy and safety of EFTR using an over-the-scope clip(OTSC).METHODS This prospective,single-center,non-randomized clinical trial was conducted at the endoscopy center of Shengjing Hospital of China Medical University.The study included patients aged 18-70 years who had gastric or colorectal submucosal tumors(SMTs)(≤20 mm in diameter)originating from the muscularis propria based on endoscopic ultrasound(EUS)and patients who had early-stage gastric or colorectal cancer(≤20 mm in diameter)based on EUS and computed tomography.All lesions were treated by EFTR combined with an OTSC for wound closure between November 2014 and October 2016.We analyzed patient demographics,lesion features,histopathological diagnoses,R0 resection(negative margins)status,adverse events,and follow-up results.RESULTS A total of 68 patients(17 men and 51 women)with an average age of 52.0±10.5 years(32-71 years)were enrolled in this study,which included 66 gastric or colorectal SMTs and 2 early-stage colorectal cancers.The mean tumor diameter was 12.6±4.3 mm.The EFTR procedure was successful in all cases.The mean EFTR procedure time was 39.6±38.0 min.The mean OTSC defect closure time was 5.0±3.8 min,and the success rate of closure for defects was 100%.Histologically complete resection(R0)was achieved in 67(98.5%)patients.Procedure-related adverse events were observed in 11(16.2%)patients.The average post-procedure length of follow-up was 48.2±15.7 mo.There was no recurrence during follow-up.CONCLUSION EFTR combined with an OTSC is an effective and safe technique for the removal of select subepithelial and epithelial lesions that are not amenable to conventional endoscopic resection techniques.
文摘An ileal pouch fistula is an uncommon complication after an ileal pouch anal anastomosis. Most patients who suffer from an ileal pouch fistula will need surgical intervention. However, the surgery can be invasive and has a high risk compared to endoscopic treatment. The over-the-scope clip(OTSC) system was initially developed for hemostasis and leakage closure in the gastrointestinal tract during flexible endoscopy. There have been many successes in using this approach to apply perforations to the upper gastrointestinal tract. However, this approach has not been used for ileal pouch fistulas until currently. In this report, we describe one patient who suffered a leak from the tip of the "J" pouch and was successfully treated with endoscopic closure via the OTSC system. A 26-year-old male patient had an intestinal fistula at the tip of the "J" pouch after an ileal pouch anal anastomosis procedure. He received endoscopic treatment via OTSC under intravenous anesthesia, and the leak was closed successfully. Endoscopic closure of a pouch fistula could be a simpler alternative to surgery and could help avoid surgeryrelated complications.
文摘This paper reports our experience with a new overthe-scope clip in the setting of recurrent bleeding and oesophageal fistula. We treated five patients with the over-the-scope Padlock Clip?. It is a nitinol ring, with six inner needles preassembled on an applicator cap, thumb press displaced by the Lock-It? delivery system. The trigger wire is located alongside the shaft of the endoscope, and does not require the working channel. Three patients had recurrent bleeding lesions(bleeding rectal ulcer, post polypectomy delayed bleeding and duodenal Dieulafoy's lesion) and two patients had a persistent respiratory-esophageal fistula. In all patients a previous endoscopic attempt with standard techniques had been useless. All procedures were conducted under conscious sedation but for one patient that required general anaesthesia due to multiple comorbidities. We used one Padlock Clip? for each patient in a single session. Simple suction was enough in all of our patients to obtain tissue adhesion to the instrument tip. A remarkably short application time was recorded for all cases(mean duration of the procedure: 8 min). We obtained technical and immediate clinical success for every patient. No major immediate, early or late(within 24 h, 7 d or 4 wk) adverse events were observed, over follow-up durations lasting a mean of 109.4 d. One patient, treated for duodenal bulb bleeding from a Dieulafoy's lesion, developed signs of mild pancreatitis 24 h after the procedure. The new over-the-scope Padlock Clip? seems to be simple to use and effective in different clinical settings, particularly in "difficult" scenarios, like recurrent bleeding and respiratory-oesophageal fistulas.
基金Supported by Program of Taizhou Science and Technology Grant,No.20ywb29Medical Health Science and Technology Project of Zhejiang Province,No.2021PY083 and No.2019KY239+2 种基金Key Technology Research and Development Program of Zhejiang Province,No.2019C03040Major Research Program of Taizhou Enze Medical Center Grant,No.19EZZDA2Open Fund of Key Laboratory of Key Laboratory of Minimally Invasive Techniques&Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province,No.21SZDSYS01 and No.21SZDSYS09。
文摘BACKGROUND Endoscopic resection of duodenal subepithelial lesions(SELs)is a difficult procedure with a high risk of perforation.At present,dealing with perforation after endoscopic resection of duodenal SELs is still considered a great challenge.AIM To evaluate the effectiveness and safety of an over-the-scope clip(OTSC)in the treatment of perforation post-endoscopic resection of duodenal SELs.METHODS From May 2015 to November 2019,18 patients with perforation following endoscopic resection of duodenal SELs were treated with OTSCs.Data comprising the rate of complete resection,closure of intraprocedural perforation,delayed bleeding,delayed perforation,and postoperative infection were extracted.RESULTS The rate of complete removal of duodenal SELs and successful closure of the perforation was 100%.The median perforation size was 1 cm in diameter.Seventeen patients had minor intraoperative bleeding,while the remaining 1 patient had considerable amount of bleeding during the procedure.Seven patients had postoperative abdominal infections,of which 1 patient developed an abscess in the right iliac fossa and another patient developed septic shock.All 18 patients recovered and were discharged.No delayed bleeding or perforation was reported.The mean time taken to resume normal diet after the procedure was 6.5 d.The mean postoperative hospital stay was 9.5 d.No residual or recurrent lesions were detected during the follow-up period(15-66 mo).CONCLUSION Closing a perforation after endoscopic resection of duodenal SELs with OTSCs seems to be an effective and reasonably safe therapeutic method.
基金Supported by National Natural Science Foundation of ChinaNo.81201908
文摘Over-the-scope clip(OTSC) system is becoming a new reliable technique which is available for the endoscopic closure of fistulas, bleeding, perforations and so on. We describe the case of a patient with a nonhealing gastrocutaneous fistula after esophagectomy for esophageal squamous cell carcinoma which was successfully closed using an OTSC system. This is the first report of the use of OTSC to treat a nonhealing gastrocutaneous fistula successfully after esophagectomy. We believe our experience will give such patients an ideal way to cure the fistula without suffering too much and also explore new application of OTSC.
文摘Non-variceal upper gastrointestinal(GI)bleeding is a significant cause of morbidity and mortality.Traditionally,through-the-scope(TTS)clips,thermal therapy,and injection therapies are used to treat GI bleeding.In this review,we provide an overview of novel endoscopic treatments that can be used to achieve hemostasis.Specifically,we discuss the efficacy and applicability of over-thescope clips,hemostatic agents,TTS doppler ultrasound,and endoscopic ultrasound,each of which offer an effective method of reducing rates of GI rebleeding.
文摘Gastrointestinal leaks and fistulae are serious, potentially life threateningconditions that may occur with a wide variety of clinical presentations. Leaks aremostly related to post-operative anastomotic defects and are responsible for animportant share of surgical morbidity and mortality. Chronic leaks and longstanding post-operative collections may evolve in a fistula between twoepithelialized structures. Endoscopy has earned a pivotal role in the managementof gastrointestinal defects both as first line and as rescue treatment. Endotherapyis a minimally invasive, effective approach with lower morbidity and mortalitycompared to revisional surgery. Clips and luminal stents are the pioneer ofgastrointestinal (GI) defect endotherapy, whereas innovative endoscopic closuredevices and techniques, such as endoscopic internal drainage, suturing systemand vacuum therapy, has broadened the indications of endoscopy for themanagement of GI wall defect. Although several endoscopic options are currentlyused, a standardized evidence-based algorithm for management of GI defect isnot available. Successful management of gastrointestinal leaks and fistulaerequires a tailored and multidisciplinary approach based on clinical presentation,defect features (size, location and onset time), local expertise and the availabilityof devices. In this review, we analyze different endoscopic approaches, which weselected on the basis of the available literature and our own experience. Then, weevaluate the overall efficacy and procedural-specific strengths and weaknesses ofeach approach.
基金Supported by the Bundesministerium für Bildung und Forschung(BMBF,KMU-innovativ:Onto Vigilance SWS365-065,FKZ 01|S12038A)within a subcontract with novineon Gmb H(partly)
文摘Conventional endoscopic resection techniques such as endoscopic mucosal resection or endoscopic submucosal dissection are powerful tools for treatment of gastrointestinal neoplasms. However,those techniques are restricted to superficial layers of the gastrointestinal wall. Endoscopic full-thickness resection(EFTR) is an evolving technique,which is just about to enter clinical routine. It is not only a powerful tool for diagnostic tissue acquisition but also has the potential to spare surgical therapy in selected patients. This review will give an overview about current EFTR techniques and devices.
文摘Duodenal endoscopic resection is the most difficult type of endoscopic treatment in the gastrointestinal tract(GI) and is technically challenging because of anatomical specificities. In addition to these technical difficulties, this procedure is associated with a significantly higher rate of complication than endoscopic treatment in other parts of the GI tract. Postoperative delayed perforation and bleeding are hazardous complications, and emergency surgical intervention is sometimes required. Therefore, it is urgently necessary to establish a management protocol for preventing serious complications. For instance, the prophylactic closure of large mucosal defects after endoscopic resection may reduce the risk of hazardous complications. However, the size of mucosal defects after endoscopic submucosal dissection(ESD) is relatively large compared with the size after endoscopic mucosal resection, making it impossible to achieve complete closure using only conventional clips. The over-the-scope clip and polyglycolic acid sheets with fibrin gel make it possible to close large mucosal defects after duodenal ESD. In addition to the combination of laparoscopic surgery and endoscopic resection, endoscopic full-thickness resection holds therapeutic potential for difficult duodenal lesions and may overcome the disadvantages of endoscopic resection in the near future. This review aims to summarize the complications and closure techniques of large mucosal defects and to highlight some directions for management after duodenal endoscopic treatment.
文摘Advances in endoscopic and surgical techniques have increased the frequency and complexity of these procedures and associated complications such as gastrointestinal perforation. With the advancements in the field of gastroenterology, the promising use of an over the scope clips(OTSC) has fulfilled the unmet need for a reliable endoscopic devise in approximation of gastrointestinal perforation. This novel approach has raised the level of confidence in endoscopist in dealing with this serious complication during endoscopy. Here we have shared our experience with OTSC to evaluate its efficacy and safety in managing iatrogenic gastrointestinal perforations during endoscopy.
文摘To demonstrate the clinical outcomes of a multicenter experience and to suggest guidelines for choosing a suction method.METHODSThis retrospective study at 5 medical centers involved 58 consecutive patients undergoing over-the-scope clips(OTSCs)placement.The overall rates of technical success(TSR),clinical success(CSR),complications,and procedure time were analyzed as major outcomes.Subsequently,56 patients,excluding two cases that used the Anchor device,were divided into two groups:14 cases of simple suction(SS-group)and 42 cases using the Twin Grasper(TG-group).Secondary evaluation was performed to clarify the predictors of OTSC success.RESULTSThe TSR,CSR,complication rate,and median procedure time were 89.7%,84.5%,1.8%,and 8(range 1-36)min,respectively,demonstrating good outcomes.However,significant differences were observed between the two groups in terms of the mean procedure time(5.9 min vs 14.1 min).The CSR of the SS-and TG-groups among cases with a maximum defect size≤10 mm and immediate or acute refractory bleeding was 100%,which suggests that SS is a better method than TG in terms of time efficacy.The CSR in the SS-group(78.6%),despite the technical success of the SS method(TSR,100%),tended to decrease due to delayed leakage compared to that in the TG-group(TSR,CSR;88.1%),indicating that TG may be desirable for leaks and fistulae with defects of the entire layer.CONCLUSIONOTSC system is a safe and effective therapeutic option for gastrointestinal defects.Individualized selection of the suction method based on particular clinical conditions may contribute to the improvement of OTSC success.
文摘The present armamentarium of endoscopic hemostatic therapy for non-variceal upper gastrointestinal hemorrhage includes injection,electrocautery and clips.There are newer endoscopic options such as hemostatic sprays,endoscopic suturing and modifications of current options including coagulation forceps and over-the-scope clips.Peptic hemorrhage is the most prevalent type of nonvariceal upper gastrointestinal hemorrhage and traditional endoscopic interventions have demonstrated significant hemostasis success.However,the hemostatic success rate is less for other entities such as Dieulafoy’s lesions and bleeding from malignant lesions.Novel innovations such as endoscopic submucosal dissection and peroral endoscopic myotomy has spawned a need for dependable hemostasis.Gastric antral vascular ectasias are associated with chronic gastrointestinal bleeding and usually treated by standard argon plasma coagulation (APC),but newer modalities such as radiofrequency ablation,banding,cryotherapy and hybrid APC have been utilized as well.We will opine on whether the newer hemostatic modalities have generated success when traditional modalities fail and should any of these modalities be routinely available in the endoscopic toolbox.
文摘BACKGROUND Radiofrequency ablation(RFA)and microwave ablation(MWA)represent the standard of care for patients with early hepatocellular carcinoma(HCC)who are unfit for surgery.The incidence of reported adverse events is low,ranging from 2.4%to 13.1%for RFA and from 2.6%to 7.5%for MWA.Gastrointestinal tract(GIT)injury is even more infrequent(0.11%),but usually requires surgery with an unfavourable prognosis.Due to its low incidence and the retrospective nature of the studies,the literature reporting this feared complication is heterogeneous and in many cases lacks information on tumour characteristics,comorbidities and treatment approaches.CASE SUMMARY A 77-year-old man who had undergone extended right hepatectomy for HCC was diagnosed with early disease recurrence with a small nodule compatible with HCC in the Sg4b segment of the liver with a subcapsular location.He was treated with percutaneous RFA and a few week later he was urgently admitted to the Surgery ward for abdominal pain and fever.A subcutaneous abscess was diagnosed and treated by percutaneous drainage.A fistulous tract was then documented by the passage of contrast material from the gastric antrum to the abdominal wall.The oesophagogastroduodenoscopy confirmed a circular wall defect at the lesser curvature of gastric antrum, leading directly to the purulentabdominal collection. An over-the-scope clip (OTSC) was used to successfullyclose the defectCONCLUSIONThis is the first reported case of RFA-related GIT injury to have been successfullytreated with an OTSC, which highlights the role of this endoscopic treatment forthe management of this complication.
基金Medical Health Science and Technology Project of Zhejiang Province,No.2021PY083,2019KY239Program of Taizhou Science and Technology Grant,No.23ywa33+2 种基金Major Research Program of Taizhou Enze Medical Center Grant,No.19EZZDA2Open Fund of Key Laboratory of Key Laboratory of Minimally Invasive Techniques&Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province,No.21SZDSYS01 and No.21SZDSYS09Program of Taizhou Enze Medical Center Grant,No.22EZD06.
文摘BACKGROUNDGiven the high incidence of esophageal cancer in China,an increasing number ofpatients there are undergoing endoscopic mucosal dissection(ESD).Although the5-year survival rate after ESD can exceed 95%,esophageal stricture,the mostcommon and serious postoperative complication,affects the long-term prognosisof patients and the quality of life.Autologous mucosal grafts have proven to besuccessful in preventing stricture after ESD for early esophageal cancer.AIMTo examine the viability of acellular dermal matrix(ADM)as an alternative to autologous mucosa for the prevention of stricture after ESD.METHODSThis is a prospective,single-center,controlled study.Consecutive patients who underwent ESD surgery and werewilling to undergo autologous mucosal transplantation were recruited between January 1 and December 31,2017.Consecutive patients who underwent ESD surgery and were willing to undergo ADM transplantation wererecruited between January 1 to December 31,2019.A final three-year follow-up of patients who receivedtransplants was conducted.RESULTSBased on the current incidence of esophageal stricture,the sample size required for both the autologous mucosalgraft group and the ADM group was calculated to be 160 cases.Due to various factors,a total of 20 patients withautologous mucosal grafts and 25 with ADM grafts were recruited.Based on the inclusion exclusion andwithdrawal criteria,9 patients ultimately received autologous mucosal grafts and completed the follow-up,while11 patients received ADM grafts and completed the follow-up.Finally,there were 2 cases of stenosis in theautologous mucosal transplantation group with a stenosis rate of 22.22%and 2 cases of stenosis in the ADMtransplantation group with a stenosis rate of 18.18%,with no significant difference noted between the groups(P=0.94).CONCLUSIONIn this prospective,single-center,controlled trial,we compared the effectiveness of autologous mucosatransplantation and ADM for the prevention of esophageal stricture.Due to certain condition limitations,we wereunable to recruit sufficient subjects meeting our target requirements.However,we implemented strict inclusion,exclusion,and withdrawal criteria and successfully completed three years of follow-up,resulting in valuableclinical insights.Based on our findings,we hypothesize that ADM may be similarly effective to autologousmucosal transplantation in the prevention of esophageal stricture,offering a comparable and alternative approach.This study provides a new therapeutic idea and direction for the prevention of esophageal stricture.
