Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Apr 27, 2016; 8(4): 315-320
Published online Apr 27, 2016. doi: 10.4240/wjgs.v8.i4.315
Over-the-scope clips in the treatment of gastrointestinal tract iatrogenic perforation: A multicenter retrospective study and a classification of gastrointestinal tract perforations
Benedetto Mangiavillano, Angelo Caruso, Raffaele Manta, Roberto Di Mitri, Alberto Arezzo, Nico Pagano, Giuseppe Galloro, Filippo Mocciaro, Massimiliano Mutignani, Carmelo Luigiano, Enrico Antonucci, Rita Conigliaro, Enzo Masci
Benedetto Mangiavillano, Gastroenterology and Gastrointestinal Endoscopy, Borea Hospital, 18038 Sanremo, Italy
Angelo Caruso, Rita Conigliaro, Gastroenterology and Gastrointestinal Endoscopy, Sant’Agostino Estense, 1355 Baggiovara, Italy
Raffaele Manta, Massimiliano Mutignani, Gastrointestinal Endoscopy Operative Endoscopy Unit, Niguarda-Ca Granda Hospital, 20162 Milan, Italy
Roberto Di Mitri, Filippo Mocciaro, Gastroenterology and Endoscopy Unit, ARNAS Civico Hospital, 90127 Palermo, Italy
Alberto Arezzo, Department of Surgical Sciences, University of Torino, 10126 Torino, Italy
Nico Pagano, Unit of Gastroenterology, S. Orsola-Malpighi University Hospital, 40138 Bologna, Italy
Giuseppe Galloro, Department of Clinical Medicine and Surgery, Special Unit of Surgical Digestive Endoscopy, University of Naples Federico II - School of Medicine, 80138 Napoli, Italy
Carmelo Luigiano, Gastrointestinal Endoscopy, San Paolo Universitary Hospital, 20142 Milan, Italy
Enrico Antonucci, Division of Surgical and Gastrointetsinal Products, Euromedical s.r.l, 25010 San Zeno Naviglio, Italy
Enzo Masci, Gastroenterology and Gastrointestinal Endoscopy, National Tumori Institute, 20162 Milano, Italy
Author contributions: Mangiavillano B, Caruso A and Manta R designed research and wrote, performed literature search and analyzed the data, edited and finalized the text; Di Mitri R, Arezzo A, Pagano N, Galloro G, Mocciaro F, Mutignani M, Luigiano C, Antonucci E, Conigliaro R and Masci E reviewed the paper for important intellectual content.
Institutional review board statement: This is a retrospective study, a case-collection. Data of the patients treated were analyzed from the clinical data of our hospitals and OTSC clip were used not for the aim of the study. The aim of the study was only to review retrospective data from the clinical records of the patients. Then, we have no need of IRB statement.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: No conflicts of interest to declare.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at b_mangiavillano@hotmail.com. Participants informed consent for data sharing was not obtained but the presented data are anonymized and risk of identification is low.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Benedetto Mangiavillano, MD, Gastroenterology and Gastrointestinal Endoscopy, Borea Hospital, via G. Borea 56, 18038 Sanremo, Italy. b_mangiavillano@hotmail.com
Telephone: +39-184-536870 Fax: +39-184-536875
Received: October 21, 2015
Peer-review started: October 22, 2015
First decision: December 11, 2015
Revised: December 15, 2015
Accepted: January 29, 2016
Article in press: January 31, 2016
Published online: April 27, 2016
Processing time: 182 Days and 9.8 Hours
Abstract

AIM: To determine the outcome of the management of iatrogenic gastrointestinal tract perforations treated by over-the-scope clip (OTSC) placement.

METHODS: We retrospectively enrolled 20 patients (13 female and 7 male; mean age: 70.6 ± 9.8 years) in eight high-volume tertiary referral centers with upper or lower iatrogenic gastrointestinal tract perforation treated by OTSC placement. Gastrointestinal tract perforation could be with oval-shape or with round-shape. Oval-shape perforations were closed by OTSC only by suction and the round-shape by the “twin-grasper” plus suction.

RESULTS: Main perforation diameter was 10.1 ± 4.3 mm (range 3-18 mm). The technical success rate was 100% (20/20 patients) and the clinical success rate was 90% (18/20 patients). Two patients (10%) who did not have complete sealing of the defect underwent surgery. Based upon our observations we propose two types of perforation: Round-shape “type-1 perforation” and oval-shape “type-2 perforation”. Eight (40%) out of the 20 patients had a type-1 perforation and 12 patients a type-2 (60%).

CONCLUSION: OTSC placement should be attempted after perforation occurring during diagnostic or therapeutic endoscopy. A failed closure attempt does not impair subsequent surgical treatment.

Keywords: Over-the-scope clip; OVESCO; Perforation; Gastrointestinal tract

Core tip: The aim of this study was to determine the outcome of over-the-scope clip management of patients with iatrogenic gastrointestinal tract perforations in eight high-volume tertiary referral centers. Technical success was of 100% and clinical success of 90%. Moreover, after evaluating our results we did a classification of the iatrogenic perforation: We defined the perforation with round-shape “type-1 perforation” and the oval-shape one as “type-2 perforation”.