Endoscopic Clips Research Articles

Complex duodenal fistula after cholecystectomy successfully treated with endoscopic suturing.

We reported a 47-year-old female with a history of laparoscopic cholecystectomy presented with a complex duodenal fistula. The bleeding artery embolization and endoscopic suture of the duodenal fistula were performed successfully. We highlight the endoscopic tissue clip suture as a safe and feasible option when surgery is too risky.

МИНИИНВАЗИВНЫЕ ТЕХНОЛОГИИ В ЛЕЧЕНИИ ОСЛОЖНЕНИЙ ОСТРОГО ПАНКРЕАТИТА

Abstract. Introduction. Hollow organ perforations accompanying pancreatic necrosis are a severe complication. In this case, surgical intervention is limited to a degree due to the extensive process in the upper abdomen and the patient’s functional condition. Aim. To share our experience in the minimally invasive repair of gastric perforation in a case series of severely infected pancreatic necroses and retroperitoneal phlegmons. Materials and Methods. We analyzed a case series in our clinic over 5 years, including the necrotizing forms of acute pancreatitis with complications, such as acute perforations of hollow organs. This paper describes the minimally invasive surgeries we performed to treat perforations in upper abdominal. Results and Discussion. In 3 of 4 cases in our clinic, acute perforations of the upper gastrointestinal tract developed along with necrotizing pancreatitis were successfully released using the minimally invasive approach. Conclusions. Hollow organ perforation is one of the most severe complications of infected pancreatic necrosis resulting from the aggressive effects of pancreatic secretion. In this case, the tactical approach depends on the nature and localization of perforation, the course of pancreatic necrosis, and the patient’s functional condition. For perforation of acute gastric ulcers, it is technically possible to use a minimally invasive approach using endoscopic clips, which has been successfully demonstrated in our clinic. We hope that our experience will allow avoiding extended operations in this category of patients.

Prevention of Migration of Esophageal Self-Expandable Metallic Stents Using Endoscopic Clips.

Background and Objectives: Esophageal stenting with self-expandable metallic stents (SEMS), for both benign and malignant reasons, has been widely practiced for decades, but migration still remains the most common complication of the procedure. In this report we aim to review our experience and results in stent fixation with clips. Materials and Methods: We present 18 patients who underwent esophageal stenting for both benign and malignant reasons. The SEMSs used were partially covered and were fixated with two to four through the scope hemostatic clips in the proximal end of the prothesis. The procedure was performed only on patients with a high risk of migration of the stent. Results: Migration occurred in only one of the above-mentioned patients and was treated with stent repositioning. The other adverse events that occurred were related to tumor growth in patients with malignant diseases. Conclusions: Clip fixation of an esophageal self-expandable metallic stent in cases considered high-risk for migration is a safe procedure. It reduces the migration rate significantly for both benign and malignant indications.

Primary omental pregnancy after in vitro fertilization complicated by hemoperitoneum—how to manage it laparoscopically

To report an uncommon case of primary OP treated laparoscopically. Ectopic pregnancy (EP) is the leading cause of maternal mortality during the first trimester and the incidence increases with assisted reproductive techniques, occurring in approximately 1.5%-2.1% of patients undergoing invitro fertilization.1 Omental pregnancy (OP) is an extremely rare form of EP accounting for less than 1% of all EPs. OP can be classified as primary or secondary on the basis of Studdiford's criteria2. The preoperative diagnosis of OP is complex and usually occur in acute circumstances during a throughout intraoperative evaluation of the abdomen.3-5 A delayed diagnosis poses a serious threat to the survival of the patient; therefore, it is important to remark that EP can exist in unusual locations and prompt surgical intervention may be necessary. A step-by-step narrated video of a rare clinical case and description of the surgical procedure. Tertiary Level Academic Hospital "IRCCS Azienda Ospedaliero - Universitaria di Bologna" Bologna, Italy. A 36-year-old woman was referred to our emergency room because of acute abdominal pain and nausea for 2 hours with no signs of hemodynamic instability. The patient also complained that poor vaginal bleeding appeared during the last 24 hours. The patient has undergone a cycle of invitro fertilization with an elective single frozen embryo transfer of a blastocyst on day 5, 2 months before. She had no relevant clinical or surgical history. Diffuse abdominal tenderness and a painful uterus at mobilization were appreciated at clinical examination. A massive hemoperitoneum was diagnosed using transvaginal-transabdominal ultrasound, and no uterine or adnexal lesions were identified. The β-human chronic gonadotropin level was 43.861 mIU/mL, and the hemoglobin value was 10.5 g/dL. On suspicion of a ruptured EP, after detailed counseling and the acquisition of informed consent, a laparoscopic exploration was planned. First, the hemoperitoneum was evacuated to allow visualization of the abdominal cavity. At pelvic inspection, no EP was found. Throughout the exploration of the abdominal cavity, a 4-cm bluish cystic mass of friable consistency was detected infiltrating the omentum and the mesentery. According to Studdiford's criteria, the diagnosis of a primary OP was established. A careful and complete excision of the ectopic implant was performed with an ultrasonic system and required a considerable hemostatic effort using bipolar energy, endoscopic clips, and mechanical compression. The postoperative course was uneventful. The β-human chronic gonadotropin levels gradually decreased to negative values within 29 days after surgery. Omental ectopic pregnancy can be successfully managed with a laparoscopic approach even in an emergency setting. Omental pregnancy can easily be overlooked, even by skilled surgeons, during laparoscopic exploration. It is mandatory that all peritoneal surfaces and the omentum be carefully inspected during surgery in patients without other signs of pelvic EP.We confirm that the patient included in this video gave consent for publication of the video and posting of the video online, including on social media, the journal website, scientific literature websites, and other applicable sites.

Laparoscopic management of iatrogenic colon perforation.

Iatrogenic colon perforation (ICP) due to colonoscopy is a severe complication and is associated with significant morbidity and mortality. The global estimated incidence of ICP is 0.03% and up to 3% for diagnostic and therapeutic colonoscopies, respectively. Treatment options include endoscopic repair, conservative therapy, and surgery. Treatment decision is based on the time and the setting of the diagnosis, the type, and location of the perforation, the presence of related pathologies, the clinical status and characteristic of the patient, and surgeon's skills. We present our experience in the treatment of ICPs. A retrospective review was undertaken of all patients suffering from ICP at Bnai-Zion Medical Center between 1/1/2010 and 1/3/2021. Clinical presentation, therapeutic approach, and short-term outcomes were analyzed. There were51 cases of ICPs. Fourteen (27%) were diagnosed by the gastroenterologist during the procedure, 2 of whom were treated with endoscopic clips. The rest of the patients (72.5%) were diagnosed in the ER after a CT scan. Forty-three patients (84%) went on to operative management: 5 (11%) operations started with laparotomy-all were conducted in the early study period (until 2013). All other operations (88%) started with a diagnostic laparoscopy, 4 of whom (10%) were converted to laparotomy. Out of the 38 laparoscopic cases 29 (80%) were treated with primary suturing. Seven patients went on to colon resection (5 of whom with primary anastomosis). Six patients required ICU admission-with 1/38 (2%) from the laparoscopic cases, and 5/9 (55%) from the laparotomy cases. A total of 49/51 (96%) patients recovered and were discharged after 5 ± 2 for conservative and laparoscopic cases, and 12 ± 9 for open cases. Laparoscopic treatment of ICP is safe and feasible in most cases. Our data supports a laparoscopic attempt at any such scenario.

Endoscopic clip-induced acute appendicitis in a patient on chronic hemodialysis: a case report with literature review

BackgroundForeign body-induced acute appendicitis is rare but could most often be caused by fish bones; those caused by endoscopic clips are highly rare. Herein, we report a case of acute appendicitis caused by endoscopic clips that developed 2 years after the endoscopic procedure.Case presentationA 68-year-old man with a 2-year history of hemodialysis (HD) for diabetic nephropathy visited our hospital with pain in the right lower quadrant. He had undergone endoscopic submucosal dissection (ESD) for gastric adenoma 2 years earlier. Abdominal computed tomography revealed acute gangrenous appendicitis and a high-density structure lodged in the appendix. This structure was determined to be an endoscopic clip that was lodged in the patient’s appendix for 2 years. The patient underwent an emergency laparoscopic appendectomy, and an endoscopic clip covered by a fecalith was found in the appendix.ConclusionEndoscopic clips usually fall off spontaneously in approximately a week and pass through stool. However, in this case, appendicitis developed 2 years after the ESD. An emergency surgical appendectomy may be recommended for appendicitis caused by foreign bodies. Prophylactic appendectomy or removal of foreign bodies should be considered for HD patients, even in the absence of symptoms owing to the potential severity of appendicitis in such patients.

Endoscopic double-layered suturing: an updated technique for clip closure of large mucosal defects after endoscopic submucosal dissection

Video 1Endoscopic submucosal dissection of a large, laterally spreading-type granular mixed polyp in the ascending colon followed by closure of the ulcer bed using modified double-layered endoscopic suturing with endoscopic clips.

S3374 Successful Endoscopic Clipping of Iatrogenic Esophageal Perforation with Massive Subcutaneous Emphysema

S3374 Successful Endoscopic Clipping of Iatrogenic Esophageal Perforation with Massive Subcutaneous Emphysema

Novel removable endoscopic clip: Usefulness in failure of traction method during endoscopic submucosal dissection.

Novel removable endoscopic clip: Usefulness in failure of traction method during endoscopic submucosal dissection.

Preoperative fluorescent clip marking vs. India ink tattooing for tumor identification during colorectal surgery.

Identifying tumor location is important in colorectal tumor resection. Preoperative endoscopic India ink marking is a widespread practice, but local injection of ink is an unstable procedure. Although it is often invisible, the ink may be sprayed into the peritoneal cavity and contaminate the surgical field. At our hospital, we introduced fluorescent clip marking (FCM) using the Zeoclip FS®, an endoscopic clip developed using near-infrared fluorescent resin. We tested the usefulness of FCM by retrospectively comparing cases in which FCM was used with cases in which conventional ink marking was used. We enrolled 305 patients with colorectal tumors who underwent colorectal surgery after preoperative marking from January 2017 to April 2022. We classified the patients into the FCM group (86 patients) and the India ink tattoo group (219 patients). Endoscopic marking was completed in the FCM group by the day before surgery, and fluorescence was evaluated during surgery with a fluorescent laparoscopic system. Patient backgrounds, marking visibility, adverse effects, and early postoperative results were retrospectively compared between groups. Marking was visually confirmed in 80 patients in the FCM group (93.02%) and in 166 patients in the India ink tattoo group (75.80%) (p = 0.0006). In the group with India ink tattoos, contamination of the surgical field was observed in seven cases (3.20%). No adverse events were observed in the FCM group. In colorectal surgery, FCM provides better visibility than the conventional India ink tattooing method and is a simple and safe marking method. Examination of fluorescence navigation for laparoscopic colorectal cancer surgery. Research Ethics Committee of the Kawaguchi Municipal Medical Center (Saitama, Japan) approval number: 2020-3. https://kawaguchi-mmc.org/wp-content/uploads/clinicalresearch-r02.pdf .

Proximal Resection Line Determination Using Intraoperative Radiography in Laparoscopic Distal Gastrectomy for Gastric Cancer.

Laparoscopic distal gastrectomy for gastric cancer has become a common procedure in many institutions. As manual palpation is impossible, various methods have been developed to identify the location of the tumor and determine the proximal resection line. Intraoperative endoscopy requires manpower and is time-consuming. The authors take an intraoperative X-ray. Here, we demonstrate our methods and outcomes. We preoperatively applied metal clips just proximal to the tumor through esophagogastroduodenoscopy. During surgery, we applied metal vessel clips to the greater and lesser curvatures of the planned resection line of the stomach and took an intraoperative X-ray to examine the distance between the planned resection line and the tumor. If the distance was appropriate, the stomach was resected on the planned line, and if the distance was judged to be insufficient, the stomach was resected on the more proximal line, as appropriate. An intraoperative frozen section of the proximal resection margin was examined, as appropriate. We performed this method for 71 patients. Tumors were successfully resected together with preoperative endoscopic clips in all patients. In five patients, intraoperative frozen section of the proximal resection margins was positive; however, additional resection confirmed negative margins. One patient underwent total gastrectomy, and the remaining 70 patients underwent distal gastrectomy. An intraoperative X-ray seems to be a simple and useful method for identifying the location of the tumor and determining the proximal resection line.

Efficacy of the endoscopic clip method in patients treated with the endoscopic clip method forgastrointestinal bleeding, perforations and fistulas.

Introduction:Gastrointestinal bleeding, perforations and fistulas are common conditions and can betreated with endoscopic procedures that are considered as minimally invasive procedures. With theintroduction of ovarian thescope clips (OTSC), the success of the procedure is increasing and its use isrecommended as the first step in treatment modalities. This study aims to contribute to the literatüre and share our experiences.
 Methods:Between 2020 and 2023, 21 patients who underwent endoscopic clipapplication after gastrointestinal tract perforations, anastomotic leaks, fistulas, bleeding andendomucosal resection in our clinic were evaluated.
 Results:A total of 21 patients, 13 males (61.9%), were included in our study. There were 16 patientsin the bleeding group, one in the anatomical leak group, one in the fistula group and three in theendomucosal resection group. No failure was seen in any patient in the bleeding group.Antithrombotic drug use did not change the success. No surgical procedure was required. At 30-dayfollow-up, only one patient (6.25%) had rebleeding and required reoperation. No complications weredetected in the procedures of endomucosal resection, fistula and clips applied in anastomotic leakage.There was a positive correlation between erythrocyte suspension replacement and length ofhospitalization (p

Indigenous technique to develop sponge for endo vaccum therapy in post-operative anastomotic leak: A case report.

Oesophageal anastomotic leaks are serious complications with high mortality (20-50%)1 especially in the post-operative setting of malignant disease. They occur in 5-30% of cases,1 usually presenting with severe mediastinal sepsis. Revision surgery has been replaced by the use of endoscopic stents, clips, glue and vacuum therapy. The latter is the simplest and least liable to further complication. As an endo sponge was not commercially available, we introduced a self-made bed-side endo sponge, with evident success.

Clinical usefulness of the hold-and-drag closure using the SB clip for large mucosal defects after colorectal endoscopic submucosal dissection.

Endoscopic clip closure of mucosal defects after colorectal endoscopic submucosal dissection (ESD) reduces the risk of postoperative adverse events, but achieving complete closure for large mucosal defects can be difficult. The aim of this study was to evaluate the effectiveness of the hold-and-drag closure using an SB clip compared with that of the conventional closure for mucosal defects after colorectal ESD. Eighty-four consecutive colorectal lesions resected by ESD at the Hiroshima Asa Citizens Hospital were registered and randomly allocated to two groups (Group A: SB clip, Group B: EZ clip), and then endoscopic closures were performed. We crossed-over to the SB clip in situations where the initial closure using an EZ clip was unsuccessful in achieving complete closure. Outcomes were compared and analyzed. Forty-two lesions were randomly assigned to groups A and B. The complete closure rate was significantly higher in group A, especially in resected specimens with a diameter of 30mm or more. Twelve lesions that failed complete closure in group B were changed to SB clips, and 95% of the whole of group B were successfully closed. There were no significant differences in procedural time, number of clips, and cost of clips between groups A and B. Compared with the conventional closure, the hold-and-drag closure using an SB clip is a more suitable method for complete closure, especially for large mucosal defects of 30mm or more. Furthermore, this is a simpler and more economical compared to a zipper closure using EZ clips.

Endoscopic tissue approximation in clinical practice and the OverStitch device: a narrative review.

The current article describes modern endoscopic technologies that allow for advanced endoscopic tissue approximation and suturing. These technologies include such devices as through the scope and over the scope clips, endoscopic suturing OverStitch device and through the scope suturing X-Tack device. Since the original introduction of the diagnostic endoscopy, progress in the field has been astonishing. Over the past several decades endoscopy has made numerous advancements allowing for a minimally invasive mechanism to treat life threatening conditions such as gastrointestinal (GI) bleeding, full thickness injuries, as well as chronic medical conditions such as morbid obesity and achalasia. A narrative review of all relevant and available literature on endoscopic tissue approximation devices over the last 15 years ago was conducted. Multiple new devices, including endoscopic clips and endoscopic suturing devices, have been developed for endoscopic tissue approximation that allow advanced endoscopic management of a wide variety of GI tract conditions. It is critical for practicing surgeons to actively participate in the development and use of these new technologies and devices in order to maintain leadership in the field, hone expertise, and to drive innovation. Further research in minimally invasive applications for these devices is needed as they continue to be refined. This article provides a general overview of the devices available and their clinical applications.

How should we evaluate the efficacy of endoscopic closure appropriately? A black box between interventions and outcomes.

Endoscopic closure has drawn attention owing to the development and clinical introduction of various endoscopic interventions in the gastrointestinal tract. A mucosal closure is expected to prevent postoperative adverse events, such as bleeding and delayed perforation, in endoscopic intraluminal resection, for example endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). Endoscopic full-thickness resection always necessitates a robust and sustained defect closure. Furthermore, gastrointestinal fistula requires a closure method that is less invasive than surgical interventions. Intentionally created defects become wider, deeper, and harder to close with only conventional methods using endoscopic clips owing to therapeutic endoscopic expansion. Therefore, dedicated suturing devices/techniques need to be further developed.

Endoscopic Clip Closure for Type I Perforation on the Convex Side of an Incognizable Duodenal Diverticulum During Transpapillary Lithotripsy

Endoscopic Clip Closure for Type I Perforation on the Convex Side of an Incognizable Duodenal Diverticulum During Transpapillary Lithotripsy

Endoscopic mucosal resection using cold snare versus hot snare in treatment for 10–19 mm non-pedunculated colorectal polyps: protocol of a non-inferiority randomised controlled study

IntroductionCold polypectomy has the advantages of simple operation, less time-consuming and fewer complications. Guidelines have recommended cold snare polypectomy (CSP) to resect small polyps sized ≤5 mm and sessile polyps...

Analysis of efficacy and safety of a new endoscopic anastomosis clip in the treatment of defects after endoscopic full-thickness resection

Objective: To investigate the efficacy and safety of a new endoscopic anastomosis clip in the treatment of defects after endoscopic full-thickness resection (EFTR). Methods: Retrospective cohort study. Fourteen patients [4 males and 10 females, aged (55.9±8.2) years (45-69 years)] with gastric submucosal tumors underwent EFTR at the First Affiliated Hospital of Soochow University were included from December 2018 to January 2021. Patients were divided into new anastomotic clamp group (n=6) and nylon ring combined with metal clips group (n=8). Preoperative endoscopic ultrasound examinations were required to all patients to evaluate the wound condition. The size of the defect, operation time required for wound closure, success rate of closure, postoperative gastric tube placement time, postoperative hospital stay, incidence of complications, preoperative and postoperative serological indexes were compared between the two groups. All patients were followed up after the operation, among which the general endoscopy was reviewed in the first month after the operation, and the telephone and questionnaire follow-up were used in the second, third, sixth month and one year after the operation to evaluate the therapeutic effect of the new endoscopic anastomosis clip and nylon rope combined with metal clip after the EFTR operation. Results: Both groups successfully completed EFTR and were successfully closed. There was no significant difference between the age, tumor diameter and defect diameter of the two groups (all P>0.05). Compared with the nylon ring combined with metal clip group, the operation time of the new anastomotic clip group was shortened [(5.0±1.8) minutes vs (35.6±10.2) minutes, P<0.001]. The operation time was shortened [(62.2±12.5) minutes vs (92.5±0.2) minutes, P=0.007]. Postoperative fasting time decreased [(2.8±0.8) days vs (4.9±1.1) days, P=0.002]. The hospital stay after operation was also shortened [(5.2±0.8) days vs (6.9±1.5) days, P=0.023]. The total intraoperative bleeding volume decreased [(20.00±5.48) ml vs (35.63±14.75) ml, P=0.031]. The patients in both groups received endoscopic examination 1 month after operation, and there was no delayed perforation and bleeding after operation. There was no obvious symptoms of discomfort. Conclusion: The new anastomotic clamp is suitable for the treatment of full-thickness gastric wall defects after EFTR, and shows advantages of shorter operation, less bleeding, and fewer postoperative complications.

A "clip-thread-elastic ring" internal traction device for endoscopic submucosal dissection of a duodenal tumor.

Duodenal endoscopic submucosal dissection (ESD) is one of the most challenging procedures. We developed a “clip–thread–elastic ring” internal traction device to facilitate ESD procedures in the duodenum ([Fig. 1]). The device consists of an endoscopic clip, a surgical thread, and an elastic ring cut with scissors from a commonly used sterile glove. Herein, we report the application of this device to facilitate an ESD procedure in a 52-year-old man with a flat tumor in the descending duodenum ([Fig. 2 a]; [Video 1]).