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Erschienen in:
01.11.2012 | Original Article
Over-the-Scope Clip Application Yields a High Rate of Closure in Gastrointestinal Perforations and May Reduce Emergency Surgery
Erschienen in: Journal of Gastrointestinal Surgery | Ausgabe 11/2012
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Background
Perforation of the gastrointestinal tract may cause various complications and may require emergency surgery, even in patients with significant comorbidities.
Methods
Seventeen consecutive patients with indication for surgery due to a visible gastrointestinal perforation were treated with OTSC application. In this study, cause of perforation, estimated size, location, rate of perforation closure, outcome and complications were reported.
Results
In 11 of 17 patients (64.7 %), OTSC application resulted in permanent closure of perforations, thus avoiding surgery. All 11 successful cases had smaller perforation lengths (5.5 ± 1.9 mm, p < 0.02), widths (3.7 ± 0.9 mm) or area (21.1 ± 9.1 mm2), had vital margins of perforations and 1.1 ± 0.3 OTSC per patient were necessary. The six unsuccessful cases (35.3 %) showed larger perforation lengths (13.4 ± 8.8 mm, p < 0.02), widths (5 ± 4.5 mm) and area (97.6 ± 149 mm2), had necrotic or soft inflammatory margins and significantly more OTSC (2.3 ± 0.5, p = 0.018) were tried.
Conclusions
OTSC application yields a high rate of endoscopic perforation closure in patients with macroscopic gastrointestinal perforation, even in an emergency setting, representing an alternative to surgery, especially when the size of the lesion is not too large and when vital or solid perforation margins are expected.