*EMBARGOED All research presented at the 2018 ACG Annual Scientific Meeting and Postgraduate Course is strictly embargoed until Monday, October 8, 2018, at 8:00 am EDT.
P1254 Efficacy of Over-the-Scope Clip (OTSC) for the Management of Perforations, Leaks, and Fistulas: A Systematic Review and Pooled Analysis of Published Literature
Author Insight from Viveksandeep Thoguluva Chandrasekar, MBBS, University of Kansas Medical Center
What’s new and important here?
Conventional treatment of GI defects is with surgical management, which is associated with significant morbidity and mortality. Technological advances in endoscopic devices have allowed for endoscopic closure of GI defects, including perforations, fistulae and leaks. The most common endoscopic approach for treatment of GI defects before the over-the-scope clip (OTSC) was the use of temporary self-expanding metallic stents (SEMs) with success rates as high as 75% but adverse events up to 46%. OTSC offers a non-operative management option for perforations, leaks and fistulas in the gastrointestinal tract. Because this is a new modality of treatment that has been upcoming since 2007 and most of the published studies are in the form of case series and reports, we performed a pooled analysis of the available literature for efficacy of these clips in management of GI defects.
The durable clinical success rates after application of the clip and at the end of follow-up was 91% for perforations and 80.4% for leaks, which was significantly higher than fistulaes, which was 66.6%. Clinical success was also higher when the clips were used as a primary modality of treatment rather than as a rescue therapy. Thus OTSC can be used as an effective treatment modality for closure of GI defects and obviate the need for surgery and significant morbidity and mortality.
Viveksandeep Thoguluva Chandrasekar, MBBS, University of Kansas Medical Center
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