OTSC System Research Articles

Endoscopic treatment of a recalcitrant esophageal fistula with new tools: stents, Surgisis, and nitinol staples (with video)

Intrathoracic esophageal anastomotic leaks are a feared complication of esophageal surgery. Beyond surgical drainage, therapeutic endoscopic intervention is increasingly indicated to effect closure of acute perforations, leaks, and fistulae. Conventional endoscopic clips and self-expanding stents are in the front line of endoscopic therapy, but even with these standard approaches, healing may remain elusive. This case report describes the use of two complementary secondary closure methods, Surgisis Soft Tissue Graft (Cook Biotech Inc, West Lafayette, IN) and the Over-The-Scope-Clipping system (OTSC system; Ovesco Endoscopy GmbH, Tuebingen, Germany) to resolve a recalcitrant esophageal fistula.

Feasibility study for secure closure of natural orifice transluminal endoscopic surgery gastrotomies by using over-the-scope clips

The secure sealing of natural orifice transluminal endoscopic surgery (NOTES) approaches to the abdominal cavity is a problem that has not been solved. The feasibility of closing iatrogenic endoscopic GI-tract perforations by using a new over-the-scope clip was recently described. To demonstrate the feasibility of endoscopic closure of transgastric NOTES approaches with a novel clip system. Acute nonsurvival animal study (porcine model; n = 9). Transgastric approaches were performed by using a needle-knife and balloon dilation. After abdominopelvic exploration, the transgastric approaches were closed by using the OTSC clipping system with suction. The procedure was performed under laparoscopic visualization. Gastrotomy lesions could primarily be closed in 8 cases. However, the laparoscopic control indicated that the clip adaptation of the wound margins was not completely airtight under maximum insufflation of the stomach in 4 of 9 cases. Nonsurvival animal study. Sufficient closure of transgastric NOTES approaches is feasible when using the OTSC system. When considering our clinical experience, the OTSC system was shown to be an uncomplicated and secure sealing technique in human beings.