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©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Aug 27, 2022; 14(8): 799-808
Published online Aug 27, 2022. doi: 10.4240/wjgs.v14.i8.799
Over-the-scope-grasper: A new tool for pancreatic necrosectomy and beyond - first multicenter experience
Markus Brand, Jeannine Bachmann, Christoph Schlag, Ulrich Huegle, Imdadur Rahman, Edris Wedi, Benjamin Walter, Oliver Möschler, Lukas Sturm, Alexander Meining
Markus Brand, Alexander Meining, Department of Internal Medicine II, University of Würzburg, Würzburg 97080, Germany
Jeannine Bachmann, Department of Surgery, Klinikum rechts der Isar, University of München, München 81675, Germany
Christoph Schlag, Department of Gastroenterology and Hepatology, University of Zürich, Zürich 8091, Switzerland
Ulrich Huegle, Department of Gastroenterology and Hepatology, Klinikum Köln-Holweide, Köln 50968, Germany
Imdadur Rahman, Department of Gastroenterology, University Hospital Southampton, Southampton SO16 6YD, United Kingdom
Edris Wedi, Department of Gastroenterology, Gastrointestinal Oncology and Interventionell Endoscopy, Sana Klinikum Offenbach, Offenbach 63069, Germany
Benjamin Walter, Department of Internal Medicine I, University of Ulm, Ulm 89070, Germany
Oliver Möschler, Department of Gastroenterology, Marienhospital Osnabrück, Osnabrück 49074, Germany
Lukas Sturm, Department of Internal Medicine II, University of Freiburg, Freiburg 79106, Germany
Author contributions: Brand M and Meining A designed the study concept and drafted the manuscript; Brand M, Bachmann J, Schlag C, Huegle U, Rahman I, Wedi E, Walter B, Möschler O, Sturm L, and Meining A performed endoscopic interventions and undertook critical revision of the article.
Institutional review board statement: This retrospective analysis of clinical data was approved by the local ethics committee (Ethik-Kommission of university Würzburg).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All authors have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Co mmons Attribution NonCo mmercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-co mmercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-co mmercial. See:
https://creativeco mmons.org/Licenses/by-nc/4.0/
Corresponding author: Markus Brand, MD, Doctor, Department of Internal Medicine II, University of Würzburg, Oberdürrbacher Street 6, Würzburg 97080, Germany. brand_m@ukw.de
Received: February 14, 2022
Peer-review started: February 14, 2022
First decision: April 5, 2022
Revised: May 8, 2022
Accepted: July 31, 2022
Article in press: July 31, 2022
Published online: August 27, 2022
BACKGROUND
Endoscopic treatment of pancreatic necrosis can be challenging and time-consuming because sticky necrotic debris is sometimes difficult to remove. The over-the-scope-grasper, a new tool that has recently become available for this purpose, might also be useful for other indications. However, clinical data on the efficacy and safety of this new device are lacking.
AIM
To evaluate the technical success and safety of the device in a multicenter setting.
METHODS
The over-the-scope-grasper was used in nine selected endoscopic centers between November 2020 and October 2021 for appropriate indications. Overall, 56 procedures were included in the study. We retrospectively evaluated procedural parameters of all endoscopic interventions using a predefined questionnaire, with special respect to technical success, indications, duration of intervention, type of sedation, and complications. In the case of pancreatic necrosectomy, the access route, stent type, number of necrosis pieces removed, and clinical handling were also recorded.
RESULTS
A total of 56 procedures were performed, with an overall technical success rate of 98%. Most of the procedures were endoscopic pancreatic necrosectomies (33 transgastric, 4 transduodenal). In 70% of the procedures, access to the necrotic cavity was established with a lumen apposing metal stent. The technical success of pancreatic necrosectomy was 97%, with a mean of 8 pieces (range, 2-25 pieces) of necrosis removed in a mean procedure time of 59 min (range, 15-120 min). In addition, the device has been used to remove blood clots (n = 6), to clear insufficiency cavities before endoluminal vacuum therapy (n = 5), and to remove foreign bodies from the upper gastrointestinal tract (n = 8). In these cases, the technical success rate was 100%. No moderate or severe/fatal complications were reported in any of the 56 procedures.
CONCLUSION
These first multicenter data demonstrate that the over-the-scope-grasper is a promising device for endoscopic pancreatic necrosectomy, which is also appropriate for removing foreign bodies and blood clots, or cleaning insufficiency cavities prior to endoluminal vacuum therapy.
Core Tip: The objective of our retrospective multicenter study was to evaluate the efficacy and safety of the over-the-scope-grasper, a new endoscopic grasping tool, originally designed for endoscopic pancreatic necrosectomy. A total of 56 procedures were evaluated, including 37 pancreatic necrosectomies with a technical success of 97%. In the other indications - removal of foreign bodies and blood clots or cleaning of insufficiency cavities before endoluminal vacuum therapy - the technical success rate was 100%. These first multicenter data show the over-the-scope-grasper as a promising tool for endoscopic pancreatic necrosectomy and beyond.
