Shanglei Liu, MD1, Thomas Savides, MD2, Syed Fehmi, MD2, Ran B Luo, MD1, Alisa M Coker, MD1, Jonathan C DeLong, MD1, Caitlin Houghton, MD1, Bryan J Sandler, MD1, Garth R Jacobsen, MD1, Santiago Horgan, MD1. 1Department of Surgery, University of California San Diego, 2Department of Gastroenterology, University of California San Diego
Evaluate our four-year experience with the Over-The-Scope-Clip (Ovesco) system for the management of acute leaks, chronic fistulae, and uncontrolled bleeding since our initial publication in 2012.
Methods and Procedures:
Retrospective chart review was conducted for all patients at UCSD who received endoscopic Ovesco clip placement from 2011 to 2015. Primary outcome is the resolution of the original indication. Secondary outcomes are re-operations and complications complications.
41 patients were identified (61% male) with average BMI of 27.3 ± 9.7. Indications for clip application were acute leaks presenting less than six month (17 patients), chronic fistulae presentating more than six months (20 patients), and uncontrolled GI bleeding (4 patients). These indications developed after an operation in 28 patients (17 upper GI surgery, 11 lower GI surgery), after endoscopic procedures in 8 patients (6 upper endoscopy, 2 lower endoscopy), and other causes in 5 patients. Anatomic distributions of clip placement were esophagus in 7, stomach in 18, colon in 11, and small bowel in 5. Nineteen (46%) patients had previously failed at least one other treatment modality before attempting Ovesco clips. Follow-up to last clinical exam was 12 months with a median follow-up of 6 months.
Thirty two (78%) patients documented final resolution. Of these, 28 (70%) patients achieved resolution only after the usage of Ovesco clips. 10 (24%) patients required multiple Ovesco clips. Five (12%) patients ultimately required a re-operation. Nineteen patients had at least 6 months of followup, of which 14 (84%) remained symptoms free. Ovesco clipping resolved acute leaks with higher frequency than chronic fistulae (94% vs 50%; P<0.01). These acute leaks resulted mainly from upper GI procedures (8 upper GI surgery, 3 upper endoscopic treatments, 2 traumatic esophageal injury, 3 colon surgery, and 1 colonic polypectomy) with similar distribution in the chronic fistulae group. Prealbumin, Albumin, BMI, and clip location within the GI tract were not significant predictors of success. Complications from clip application use were pain in 2 (5%) patients and hematemesis in 1 (3%) patient.
Ovesco clips are a safe and effective way of managing post-procedural complications that may have otherwise resulted in high-risk reoperations. It is most effective when used in the acute phase of complications and can often be used when other modalities have failed.