Scope Clip Research Articles

Persistent Ostomy Following Percutaneous Endoscopic Gastrostomy Removal: Treatment Strategies.

The purpose of this article is to review available literature on management of persistent ostomy following PEG tube removal. We will discuss the incidence of persistent gastrocutaneous fistula (GCF) following PEG tube removal, risk factors for their development, and management strategies that have been proposed and their efficacy. The use of over the scope clips (OTSC) have evolved recently in the management of gastrointestinal bleeding, perforation, and fistula closures. OTSC has become more readily available and proven to be effective and safe. Suturing devices have shown promising results. Persistent gastrocutaneous fistula following PEG removal is a rare yet serious complication that can lead to continuous skin irritation and leakage of gastric contents and acid. There are several postulated risk factors but the most important of these is duration of placement. Management can include medical therapy which has recently been shown to be somewhat effective, endoscopic therapy and surgery as a last resort. Overall, the data on GCFs is limited and further study with larger sample size is needed.

Assessment and Techniques for Endoscopic Closure.

Endoscopic closure is an essential technique to perform safe advanced endoscopy. Without appropriate closure of a defect, patients can experience spillage of fecal contents into the peritoneal cavity resulting in abdominal sepsis. The essential components to performing endoscopic closure are assessing the defect appropriately and choosing the correct closure technique. Assessing the defect involves five separate elements: timing, size, depth, shape, blood flow, and location in the colon or rectum. Understanding how each of these elements contributes toward a successful closure allows an endoscopist to choose the proper technique for closure. There have been many types of closure techniques described in the literature but the most common are through the scope clips, over the scope clips, and endoscopic suturing. There are advantages and disadvantages of each of these closure techniques. In this manuscript, we will discuss these common techniques as well as some additional techniques and the situations where they can be employed.

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.

Endoscopic Management of Postoperative Esophageal and Upper GI Defects-A Narrative Review.

Anastomotic defects are deleterious complications after either oncologic or bariatric surgery, leading to high morbidity and mortality. Besides surgical revision in early stages or instable patients, endoscopic treatment has become the mainstay. To date, many options for endoscopic treatment in this setting exist, including fully covered metal stent placement, endoscopic vacuum therapy (EVT), endoscopic internal drainage with pigtail placement (EID), leak closure with through the scope or over the scope clips, endoluminal suturing, fibrin glue sealing and a combination of all these techniques. Current evidence is mostly based on retrospective single and multicenter studies. No guidelines exist in this important field. Treatment options have to be chosen upon each case individually, taking into account clinical and anatomic criteria, such as timing, size, infectious wound complications and hemodynamic stability. Local expertise and availability of treatment devices need to be taken into account whenever choosing a treatment strategy. This review aimed to present current treatment options in terms of effectiveness, advantages and disadvantages in order to guide the clinician for his decision making. Additionally, we aimed to provide a treatment algorithm.

S2856 Poke the Bear and Get the Claws: Life-Threatening Bleeding by Hepatic Artery Infusion Pump Fistula Managed by Over the Scope Clip Closure

Introduction: Hepatic artery infusion (HAI) pumps may be used for regional delivery of chemotherapy for treatment of colorectal cancer liver metastases. Complications are rare, but can include arterial thrombus and catheter dislocation. We present a case of duodenal fistula associated with hepatic artery infusion pump and subsequent closure with over the scope clip. Case Description/Methods: We present the case of a 57-year-old male with stage IV colon adenocarcinoma and liver metastasis who underwent placement of hepatic artery infusion (HAI) pump for local chemotherapy. 6 months later, he presented with 3 days of melena and fatigue with vitals demonstrating heart rate 129 bpm and blood pressure was 111/69 mmHg. Notably, hemoglobin was 9.1 g/dL, down from a baseline of 14.4 g/dL. He was admitted to the surgical oncology service and gastroenterology was consulted for suspected upper GI bleed. Esophagogastroduodenoscopy (EGD) performed the day after admission revealed suspected fistula in the duodenal bulb. Bleeding resolved with proton pump inhibitor therapy alone with plan for outpatient repeat endoscopy. 1 month later the patient presented with anemia, melena and acute blood loss. Repeat EGD demonstrated a bleeding duodenal bulb lesion and hemostasis was achieved by placement of a 12/6t over the scope clip placement. Subsequent CTA scan identified the hepatic artery infusion pump tip adjacent to over the scope clip in the proximal duodenum with no extravasation suggesting resolution of bleeding after clip placement. (Figure) Discussion: We present a rare case of duodenal bleeding due to hepatic artery infusion catheter tip dislocation. A large single center experience of 544 patients over a 15-year period demonstrated the most common complications from HAI to include arterial thrombosis (6%), catheter occlusion/dislodgement (6%) and extrahepatic perfusion (3%)1. Furthermore, literature search for cases from 1975-2022 reveals fewer than 10 cases with this bleeding complication. In this case we demonstrate the successful use of an OTSC to manage bleeding associated from the fistula created by the infusion pump catheter between hepatic artery and duodenal bulb.Figure 1.: A: Index endoscopy showing fistula in the bulb of the duodenum. B: Subsequent endoscopy with bleeding fistula. C: Fistula closure and successful hemostasis with over the scope clip. D: CT scan showing clip with close approximation to the hepatic artery infusion catheter tip.

S347 Endoscopic Suture Repair of a Transmural Esophageal Perforation

Introduction: Iatrogenic esophageal perforations during endoscopic procedures are associated with considerable morbidity and mortality. Traditional management of large esophageal perforations included an aggressive approach involving surgery, but despite advances in techniques, postoperative complications remain high. Conservative management with endoscopic suturing and stenting has drastically improved patient outcomes. Herein, we present a patient with a guidewire associated 12 cm full thickness esophageal perforation that was successfully repaired by endoscopic suturing and stent placement. Case Description/Methods: A 60-year-old female with pmhx of GERD and chronic dysphagia presented s/p outpatient EGD empiric guidewire assisted dilation to 54Fr that was complicated by an approximately 12cm full thickness esophageal tear/perforation and pneumomediastinum. On endoscopic evaluation a large esophageal perforation was found 40 cm from incisors. A total of 4 endoscopic sutures were used to approximate the edges of the perforation in an interrupted fashion. A 15 cm fully covered stent was then endoscopically deployed over the defect with 2 sutures used for stent fixation. Following the procedure, CT esophagram showed absence of an esophageal leak. She underwent repeat EGD 2 weeks later for stent removal which showed adequate healing of the esophagus and no evidence of ongoing defect or perforation. Discussion: Endoscopic suturing was first approved by the USDA in 1998 and its uses have expanded to the repair of fistulas, perforations and anastomotic leaks. The closure technique involves approximating the defect edges using continuous and interrupted sutures, via an endoscopic suturing device. The size of the perforation limits other endoscopic interventions including over the scope clips (OTSC) which are effective in closing perforations up to 1-2 cm in size. Sharaiha et al. reported the successful closure of esophageal perforations in 13 patients using endoscopic suturing. However, the defect size ranged from 25 to 50 mm in length, much smaller than the case we present which included a 12 cm transmural defect. Further, endoscopic suturing alone is not as effective in perforation closure when compared to the addition of stent placement. Watch the video at https://tinyurl.com/ACGAbstractS347

S1106 Analysis of Reported Adverse Events Related to Over the Scope Clips: A MAUDE Database Analysis

Introduction: Over-the-scope clips (OTSC) have been increasingly used in the management of bleeding, perforations, fistulae, and anastomotic leaks in the gastrointestinal tract. However, since their Food and Drug Administration (FDA) approval in 2010, data on the adverse events of OTSC systems has been lacking. Our study aims to report and analyze adverse events and device failures associated with OTSC systems using the FDA’s Manufacturer and User Facility Device Experience (MAUDE) database. Methods: We analyzed the post-marketing surveillance data from the FDA MAUDE database of the two OTSC systems available in the United States: The Padlock clip system and the Ovesco OTSC from April 2017 through May 2022. Results: Thirty-six medical device reporting claims were found from May 2017 through May 2022. Adverse events were classified as device-related problems and patient-related adverse events. Thirty-six device-related problems were reported, along with sixteen device-related adverse events (Table). Most device-related problems were reported in the Padlock defect closure system (n=23), followed by the Padlock pro clip system (n=8) and Ovesco OTSC clip system (n=5). The most common device-related problem was related to the failure of deployment of OTSC (n=14), followed by material protrusion or extrusion (n=6). The most common patient adverse events were perforation (n=4), bleeding (n=3), esophageal laceration (n=3) and luminal stenosis (n=2). Three out of four perforations were in the Padlock pro select closure system. All four patients required surgical management of the perforation. No deaths related to the use of OTSC were reported. Conclusion: Using the data from a publicly available database, the overall adverse events from OTSC systems remain low. Failure of OTSC deployment and perforation were the most common device-related problem and patient-related adverse events, respectively. The identification of common adverse events has the potential to optimize device design and patient outcomes. It is important for endoscopists to be mindful of these potential adverse events when using over-the-scope clips. Table 1. - Device-related problems and adverse events Device-related problems Number Failure of OTSC deployment 14 Other 8 Separation problems 3 Detachment of the device 2 Protrusion or extrusion of over the scope clip system 6 Defective device component 2 Failure of positioning of the device 1 Total 36 Patient related- adverse events Number Gastro-gastric fistula 1 Perforation 4 Local trauma 1 Pain 1 Bleeding 3 Pyloric stenosis 1 Colonic stenosis 1 Esophageal laceration 3 Ulcer 1 Total 16

S2853 Novel Endoscopic Technique for Treatment of Candy Cane Syndrome

Introduction: Candy cane syndrome is an underrecognized complication of Roux-en-Y gastric bypass resulting from a long blind afferent Roux limb at the gastrojejunostomy causing nausea, vomiting, reflux and pain due to food accumulation. We present a case of novel endoscopic treatment of candy cane syndrome. Case Description/Methods: 67-year-old female with vertical banded gastroplasty revised to Roux-en-Y gastric bypass and multiple open abdominal surgeries presented with worsening of persistent post prandial epigastric pain. Upper endoscopy showed Roux-en-Y anatomy. Also noted was gastro-gastric (GG) fistula (A) and an embedded over the scope clip (OTSC) in this area (B). There were no medical records of placement of the clip or patient recall of OTSC clip. A fluoroscopic upper GI series showed candy cane loop and gastro-gastric (GG) fistula (D). Her bariatric surgeon felt that her acute symptoms were likely from candy cane syndrome. Given that she had a fairly extensive surgical history she was deemed high risk for surgery, decision made to offer endoscopic therapy for candy cane syndrome. APC (1L/min, 50W) was used to coagulate the mucosal layer of the entire afferent limb (F) and then the enteric walls of the afferent limb were approximated by placing three purse string sutures using endoscopic suturing device attached to a 2-channel therapeutic upper endoscope (G). Sutures started from the end of the blind limb towards the GJ anastomosis leading to total closure of the afferent limb (Pic 1H). One month follow up upper GI series showed direct transit of most of the contrast into efferent limb with redemonstration of a much smaller though persistent candy cane limb (I and J). (Figure) Discussion: Candy cane syndrome results from creation of a long nonfunctional limb during creation of gastro-jejunostomy at time of gastric bypass. This causes intestinal dysmotility resulting in stasis, and gradual expansion of the limb over time. Upper GI series has been used traditionally to diagnose this condition though endoscopic demonstration of off-axis orientation of roux limb using a simple guide wire has also been proposed. Historically, it has been managed surgically. We present an interesting case of endoscopic reduction of candy cane loop using advanced endoscopic suturing technique.Figure 1.: (A) Roux-en-Y anatomy with afferent limb (blue), efferent limb (yellow). (B) Metallic prong seen in the lumen of gastric pouch. (C) Metallic FB identified as OTSC clip on x ray. (D) Upper GI series demonstratingrapid pooling of contrast in candy cane limb (blue) and the Roux limb (yellow). (E) fistula seen adjacent to the clip. (F) ablated afferent limb mucosa. (G) purse string suturing of the ablated afferent limb. (H) completely obliterated of afferent limb after sutures. (I) upper GI series 1 month later shows transit of most contrast from gastric pouch (red) into Roux limb (yellow) but a persistent cany cane limb (blue). (J) one month post suturing endoscopic view of closed afferent limb.

S2827 Endoscopic Full Thickness Resection of a Sigmoid Colon GIST Diagnosed by EUS FNA

Introduction: Subepithelial lesions of colon are often encountered during colonoscopy with lipoma being a common etiology, with other etiologies such as neuroendocrine tumors, leiomyoma, schwannoma, and GIST being rare. While a lipoma can be diagnosed by endoscopic appearance, pillow sign, and fat on biopsy; a diagnostic dilemma is presented if these findings are not present. EUS can be used for lesions that are within reach of an echoendoscope, but the sonographic appearance may still not be diagnostic without tissue sampling. This is a case of a subepithelial lesion in the sigmoid colon noted on colonoscopy that was diagnosed as a gastrointestinal stromal tumor by EUS FNA. Case Description/Methods: A 67 year old man was noted to have a one centimeter smooth round lesion in his sigmoid colon on screening colonoscopy. The endoscopic appearance was consistent with a subepithelial lesion. A pillow sign was negative, showing a firm mobile mass. He was referred for endoscopic ultrasound. A radial echoendoscope was used to localize the lesion. It was round, well demarcated, hypoechoic, and originated in the fourth layer (muscularis propria). The radial scope was exchanged for a linear echoendoscope and FNA was performed using a 20 gauge biopsy needle. Pathology showed a spindle cell lesion that was positive for CD 117 staining consistent with a gastrointestinal stromal tumor. Multidiscipline discussion with colorectal surgery was had, and the decision to proceed with endoscopic resection using an over the scope clip to perform full thickness resection. Following the resection the patient had some post-procedure pain and was hospitalized for observation, treated with antibiotics, and serial imaging. No perforation was noted. Final pathology showed a 1.7cm low grade GIST with positive microscopic margins. Multidiscipline discussion at tumor board recommends continued surveillance for the low grade GIST. (Figure) Discussion: Colonic GISTs are rare lesions with variable clinical courses. Full thickness endoscopic resection is an option using either an over the scope clip or dedicated full thickness resection device, or surgery are available options for management. Size, location, and multidiscipline discussion are needed to determine the best management strategy.Figure 1.: 4th layer hypoechoic lesion, sigmoid colon.

S2592 Ethical Decision Making in Endoscopic Treatment of a Jehovah’s Witness With Severe Upper Gastrointestinal Bleeding

Introduction: For endoscopic procedures, informed consent elevates patient autonomy and circumvents medical paternalism. However, when procedures carry significant risk of harm, clinicians may unintentionally overlook patient preferences when making decisions. We present the case of a Jehovah’s Witness with upper gastrointestinal bleeding who was offered endoscopic intervention despite a high risk of peri-procedural mortality, with emphasis placed on the shared-decision making process. Case Description/Methods: A 77-year-old female Jehovah’s Witness presented with hematemesis and hemoglobin of 4.9 grams/deciliter (g/dL). Endoscopy demonstrated a duodenal ulcer with a visible vessel. Due to the inability to transfuse blood and risk of provoking further bleeding, the decision was made to forego clipping or cauterization and treat only with hemostatic powder (Figure 1). On hospital day 3 she experienced new melena with decrease in hemoglobin to 2.8 g/dL. Although providers were hesitant to offer repeat endoscopy given her lack of hemodynamic reserve, a nuanced discussion with the patient elucidated her wish to undergo all possible interventions even at high risk of death (Figure 2). Endoscopy was performed despite low hemoglobin, which redemonstrated the duodenal ulcer with a large pulsatile visible vessel. The ulcer was injected with epinephrine and an over-the scope clip was successfully placed (Figure 3). She initially stabilized, however on hospital day 5 she developed recurrent melena with hemodynamic instability. After discussion with her family, she was transitioned to comfort care measures and expired that evening. Discussion: When faced with the possibility of patient harm, gastroenterologists may intentionally withhold interventions due to a desire to act in what is perceived to be in the best interest of the patient. Ethically, however, acting by omission devalues both patient autonomy and the right to self-determination in care. This effect may be amplified by pre-existing stigma such as with the Jehovah’s Witness wherein refusal of blood products may be erroneously interpreted to imply a broader refusal of other life-saving treatments. In this case, through juxtaposition of two procedures, we demonstrate that this phenomenon can be circumvented via thoughtful discussion of all potential options with patients, regardless of physician preference. We hope to highlight the importance of this ethical concept when approaching patients for informed consent.Figure 1.: Ulcer with visible vessel on initial endoscopy, treated only with hemostatic powder. (2) Four-box model approach to ethical decision making in this case. (3) Same ulcer on repeat endoscopy, now with a pulsatile visible vessel, treated with an over-the-scope clip.

Endoscopic Full Thickness Resection: A Systematic Review

Abstract Background Endoscopic full thickness resection (EFTR) is an emerging therapeutic option for resecting subepithelial lesions (SELs) and epithelial neoplasms. We aimed to systematically review the techniques, applications, outcomes, and complications of EFTR. Methods A systematic literature search was performed using PubMed. All relevant original research articles involving EFTR were included for the review along with case report/series describing novel/rare techniques from 2001 to February 2022. Results After screening 7,739 citations, finally 141 references were included. Non-exposed EFTR has lower probability of peritoneal contamination or tumor seeding compared with exposed EFTR. Among exposed EFTR, tunneled variety is associated with lower risk of peritoneal seeding or contamination compared with non-tunneled approach. Closure techniques involve though the scope (TTS) clips, loop and clips, over the scope clips (OTSC), full thickness resection device (FTRD), and endoscopic suturing/plicating/stapling devices. The indications of EFTR range from esophagus to rectum and include SELs arising from muscularis propria (MP), non-lifting adenoma, recurrent adenoma, and even early gastric cancer (EGC) or superficial colorectal carcinoma. Other indications include difficult locations (involving appendicular orifice or diverticulum) and full thickness biopsy for motility disorders. The main limitation of FTRD is feasibility in smaller lesions (<20–25 mm), which can be circumvented by hybrid EFTR techniques. Oncologic resection with lymphadencetomy for superficial GI malignancy can be accomplished by hybrid natural orifice transluminal endoscopic surgery (NOTES) combining EFTR and NOTES. Bleeding, perforation, appendicitis, enterocolonic fistula, FTRD malfunction, peritoneal tumor seeding, and contamination are among various adverse events. Post OTSC artifacts need to be differentiated from recurrent/residual lesions to avoid re-FTRD/surgery. Conclusion EFTR is safe and effective therapeutic option for SELs, recurrent and non-lifting adenomas, tumors in difficult locations and selected cases of superficial GI carcinoma.

TU1.12 Video Presentation: The OVESCO Clip for Endoscopic Treatment of Gastrocutanoeus Fistula

Abstract Background Percutaneous endoscopic gastrostomy (PEG) is an important route of nutrition in many patients. PEG removal usually leads to spontaneous closure in a few days. Gastrocutaneous fistula (GCF) after PEG removal is an uncommon complication occurring in 2% of patients. Despite its rarity, it is responsible for significant morbidity and reduced quality of life. Treatment is initially focused on medical management and endoscopic clipping, with advanced endoscopic techniques and surgery reserved for selected cases. Method We present a video presentation demonstrating successful endoscopic treatment of GCF using the OVESCO Over the Scope clip with resolution of symptoms and closure of the fistula tract. The device is a novel innovation designed to achieve tissue apposition and compression without ischaemia. It is licensed for Gastrointestinal iatrogenic defects, endoscopic perforation, bleeding and GCF. The 72 year old patient had debilitating symptoms of gastric leakage for over a year despite previous attempts at endoscopic clipping, fibrin glue and curettage of the fistula tract. Results As shown in the video, the clip achieved good opposition with no post procedural leak. The patient was reviewed at 3 and 12 months with no recurrence of their symptoms. The external cutaneous opening had closed at 3 months. The patient reported an increase in weight, improved mood and a greater quality of life following the intervention. Conclusion The OVESCO clip has been proven to facilitate successful endoscopic closure of GCF in selected patients in whom initial treatment measures have failed. This mitigates the need and risks of surgical closure.

Endoscopic Closure of Large Iatrogenic Duodenal Perforation: Right Use of Endoscopic Accessories

AbstractPerforations during endoscopic retrograde cholangiopancreatography (ERCP) is a rare but dreadful complication. Type I Stapfer's perforations tend to be large and can get easily complicated by peritonitis and collections if not recognized and managed in a timely manner. With advancement in endoscopic accessories, endoscopic closure is usually attempted first, and surgical interventions are reserved only in patients with a failed endoscopic attempt. Though over the scope clips (OTSC) are used in patients with defect up to 20 to 25 mm in gastric or duodenal perforation and up to 30 mm in colonic perforations, larger defects can be also closed with the right use of adjuvant accessories. Here, we report our experience of successful closure of a large duodenal perforation during ERCP, using a single OTSC clip with help of accessories.

Combined endoscopic and radiologic intervention for management of acute perforated peptic ulcer: a randomized controlled trial

BackgroundPeptic ulcer perforation is a common life-threatening surgical emergency. Graham omental patch is performed for plugging of perforated peptic ulcer. Many endoscopic methods have been used to treat acute perforated peptic ulcer such as over the scope clips, standard endoscopic clips, endoscopic sewing and metallic stents. The main idea in endoscopic management of acute perforated peptic ulcer is early decontamination and decrease sepsis by interventional radiologic drainage.MethodsThis is a prospective randomized controlled clinical trial. This study included patients who were developed acute perforated peptic ulcer manifestations and were admitted to our hospital between December 2019 and August 2021. Sample size was 100 patients divided into 2 equal groups. Endoscopic group (EG): included 50 patients who were subjected to endoscopic management. Surgical group (SG): included 50 patients who were subjected to surgical management.ResultsOne hundred patients were randomized into 2 groups: SG (50) and EG (50). Median age of patients was 36 (range 27:54) and 47 (range 41:50) years-old in SG and EG, respectively. Males constituted 72% and 66% in SG and EG, respectively. Median length of postoperative hospital stay was 1 (range: 1–2) days in EG, while in SG was 7 (range 6–8) days. Postoperative complications in SG patients were 58% in form of fever, pneumonia, leak, abdominal abscess, renal failure and incisional hernia (11%, 5%, 5%, 3%, 2% and 3%, respectively). Postoperative complications in EG patients were 24% in form of fever, pneumonia, leak, abdominal abscess, renal failure and incisional hernia (10%, 0%, 2%, 0%, 0% and 0%, respectively).ConclusionCombined endoscopic and interventional radiological drainage can effectively manage acute perforated peptic ulcer without the need for general anesthesia, with short operative time, in high risk surgical patients with low incidence of morbidity & mortality.

Endoscopic Treatment of Enterocutaneous Fistulas in Crohn's Disease.

Management of enterocutaneous fistulas in Crohn's disease is challenging. Most patients still need intestinal resection in the biologic era. The aim of this study was to evaluate the efficacy of endoscopic treatment for enterocutaneous fistulas. This is a retrospective study of medical records. This study was conducted in a single institution. All consecutive patients with Crohn's disease with an enterocutaneous fistula who underwent endoscopic fistula closure with the use of an over-the-scope clip or a hemostatic clip were included. The main outcome measured was the clinical success 3 months after the procedure, which was defined as the complete closure of all fistulas at physical examination and complete cessation of the drainage from the external opening, without surgery. Eight patients (men, 25%; median age 45 years [interquartile range, 33-51]) were followed. Fistulas were localized at the ileocolonic or colocolonic anastomosis in 7 patients and at the stomach in 1 patient. Seven patients were treated with an over-the-scope clip, and one was treated with a hemostatic clip. Technical success was achieved in all cases. Clinical success at 3 months was achieved in 75% of cases (6/8 patients). After a median 16-month (interquartile range, 13-23) follow-up, 3 of 8 (37.5%) patients had enterocutaneous fistula closure and 2 of 8 (25%) needed intestinal resection. No complications were observed. The retrospective nature, the small sample size of the study, and the heterogeneity of the population limit the interpretation of the results. Endoscopic treatment of enterocutaneous fistulas is feasible with a short-term effectiveness. Additional studies are needed to confirm these results. See Video Abstract at http://links.lww.com/DCR/B614. ANTECEDENTES:Es desafiante el manejo de las fístulas enterocutáneas en enfermedad de Crohn. En la era biológica, la mayoría de los pacientes todavía requieren de resección intestinal.OBJETIVO:Evaluar la eficacia por tratamiento endoscópico de fístulas enterocutáneas.ENTORNO CLINICO:Estudio retrospectivo de registros médicos.AJUSTE:Realizado en una sola institución.PACIENTES:Se incluyeron todos los pacientes consecutivos con fístula enterocutánea en enfermedad de Crohn, sometidos a cierre endoscópico de la fístula con clip sobre el endoscopio o clip hemostático.PRINCIPALES MEDIDAS DE VALORACION:El éxito clínico a los 3 meses después del procedimiento. Definido al examen físico, como el cierre completo de todas las fístulas y cese completo del drenaje por la abertura externa, sin cirugía.RESULTADOS:Se estudiaron a ocho pacientes (hombres, 25%, mediana de edad de 45 años (rango intercuartílico, 33-51)). En 7 pacientes, las fístulas se localizaron en la anastomosis ileocolónica o colocolónica y un paciente, en el estómago. Siete pacientes fueron tratados con clip sobre el endoscopio y uno con clip hemostático. Se logró éxito técnico en todos los casos. Se logró éxito clínico a los 3 meses en 75% de los casos (6/8 pacientes). Después de una mediana de 16 meses (rango intercuartílico, 13-23), de seguimiento 3/8 (37,5%) pacientes presentaron cierre de fístulas enterocutáneas y 2/8 (25%) requirieron resección intestinal. No se observaron complicaciones.LIMITACIONES:Estudio retrospectivo, pequeño tamaño de la muestra y heterogeneidad de la población, limitaron la interpretación de los resultados.CONCLUSIONES:Es posible el tratamiento endoscópico de fístulas enterocutáneas con efectividad a corto plazo. Se requieren nuevos estudios para confirmar estos resultados. Consulte Video Resumen en http://links.lww.com/DCR/B614. (Traducción-Dr. Fidel Ruiz Healy).

Over-the-scope-clip (OTSC®) as a rescue treatment for gastrointestinal bleeding secondary to peptic ulcer disease.

over-the-scope-clips (OTSC®) have been proposed as a rescue treatment for bleeding peptic ulcers. However, their effectiveness has not been evaluated in Spain. this retrospective and single-center study (January 2018-December 2021) assessed the technical success, clinical success and safety of the device within 30 days. All patients with upper gastrointestinal bleeding due to a peptic ulcer and treated with the OTSC® clip (OVESCO) as a rescue therapy were included in the study. a total of eleven patients were included in the study, nine due to rebleeding and two due to persistent bleeding. Technical success was 81.9 % (9/11, confidence interval [CI] 95 %: 52-95 %). The per-protocol and intention-to-treat clinical success were 88.9 % (8/9, CI 95 %: 57-98 %) and 72.7 % (8/11, CI 95 %: 43-90 %), respectively. No device-related adverse effects were recorded. the OTSC® clip was an effective and safe rescue therapy for bleeding peptic ulcers.

The use of over the scope clip (OTSC) in cases of gastrointestinal bleeding with difficulty in hemostasis

The use of over the scope clip (OTSC) in cases of gastrointestinal bleeding with difficulty in hemostasis

S2384 Recurrent GI Bleeding From Colo Pancreatic Fistula – A Rare Entity

Introduction: Acute pancreatitis is an acute inflammatory condition affecting the pancreas. Colonic complications rarely occur with acute and chronic pancreatitis. Localized ileus, obstruction, colonic ischemia, hemorrhage and fistula formation have been reported together with acute pancreatitis. Colo-pancreatic fistula occurs at a rate of 3% to 10% in patients with severe acute pancreatitis. Here, we discuss the case of a patient with recurrent GI bleeding from a colo-pancreatic fistula. Case Description/Methods: A 62-year-old White male with past medical history of COPD, CAD s/p PCI, history of paroxysmal atrial fibrillation on Eliquis, diabetes presented with complaints of bleeding per rectum. He denied any other complaints. MRI abdomen showed pancreatic pseudocyst with possible fistulization of the pancreatic pseudocyst to the proximal descending colon (Fig 1A). Patient underwent EGD and colonoscopy. Colonoscopy showed evidence of pancreatico enteric fistula distal to the splenic flexure, the remnants were cleared on lavage and patient was discharged once stable (Fig 1B). One month later patient presented with another episode of recurrent GI bleeding he required 2 units of PRBC given the prior findings on the colonoscopy, patient was referred to pancreatic surgeon for further intervention of the colo-pancreatic fistula. Discussion: CPF is a rare condition associated with high mortality in patients with acute pancreatitis. Abdominal CT with or without contrast is often used for diagnosis; however, colonoscopy is also used to detect CPF. Given the anatomical proximity of the left part of the colon to the pancreas, CPF is commonly seen on the left side. Patients present with symptoms such as nausea, abdominal pain, vomiting and gastrointestinal bleeding. In contrast to other pancreatic enteric fistulas, CPF is associated with a high risk of severe hemorrhage, perforation or infection. Unlike other pancreatic enteric fistulas CPF do not close spontaneously, surgery is often the recommended treatment; however, less invasive endoscopic interventions, such as those using conventional hemoclips or over the scope clip, have been reported to have successful outcomes.Figure 1.: Fig 1A: MRI Abdomen showing pancreatic pseudocyst (shown by two blue arrows). Fig 1B: Colonoscopy showing fistulous opening in the descending colon distal to splenic flexure (shown by black arrow).

ERCP後十二指腸穿孔に対しOver–The–Scope Clipが奏効し早期に化学療法を施行した胆囊癌の1例

ERCP後十二指腸穿孔に対しOver–The–Scope Clipが奏効し早期に化学療法を施行した胆囊癌の1例

Successful closure using endoscopic ligation with O-ring and over-the-scope clip in gastric iatrogenic perforation.

Successful closure using endoscopic ligation with O-ring and over-the-scope clip in gastric iatrogenic perforation.