Application of the OTSC System for the Closure of Fistulas, Anastomosal Leakages and Perforations within the Gastrointestinal Tract

Zusammenfassung

Der Vollwandverschluss im Gastrointestinaltrakt ist eines der interessantesten Entwicklungsgebiete in der Endoskopie und war in den vergangenen Jahren entweder nur mit Prototypen oder technisch nicht ausgereiften Methoden möglich. Mit dem neuen „over the scope clipping system” (OTSC-System®), welches vom Design und Funktion einer Bärenfalle ähnelt, steht seit kurzer Zeit eine Methode des endoskopischen Vollwandverschlusses zur Verfügung, mit dem sich Fisteln, Insuffizienzen oder Perforationen verschließen lassen. Hier wird eine Fallserie von 10 Patienten vorgestellt, bei denen Fisteln (ösophagotracheal, ösophagopleural, gastrokutan und kolovesikulär), Perforationen (nach Mukosektomie, nach Papillotomie und nach PEG-Fehlanlage) und Insuffizienzen (nach Gastrotomie und Gastrektomie) im Gastrointestinaltrakt in 9 von 10 Fällen erfolgreich durch das OTSC-Systems® verschlossen wurden. In einem weiteren Fall konnten erste Erfahrungen mit dem OTSC-System® zur Vermeidung von Perforationen bei tiefer endoskopischer R 0-Nachresektion eines T 1(sm1)G1-Sigmakarzinoms nach primärer R 1-Resektion demonstriert werden.

Abstract

Until recently there has been no technique available which reproducibly and safely allowed endoscopic closures of penetrating defects within the digestive tract. With the new ”over the scope clipping system” (OTSC system®), which regarding design and function is similar to a bear-trap, a method is available for the endoscopic closure of fistulas and perforations. Here, we present a series of 10 patients, in whom different penetrating defects within the digestive tract could be closed in 9 of 10 cases successfully by the OTSC system®: fistulas (esophagotracheal, esophagopleural, gastrocutaneous and colovesical), perforations (after mucosectomy, after papillotomy and PEG misplacement) and anastomosal leakages (after gastrotomy and gastrectomy). In another case we demonstrate our first experience with the OTSC system® for the prevention of perforations during deep endoscopic R 0 resection of a T 1(sm1)G1 sigmoideal cancer after initial R 1 resection.

Schlüsselwörter

OTSC-System - Fisteln - Insuffizienzen - Perforationen - Vollwandverschluss

Key words

OTSC system - fistulas - anastomosal leakages - perforations - full-thickness resection

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