OTSC system for the treatment of gastrointestinal perforations Sistema de clip-OTSC para el tratamiento de las perforaciones gastrointestinales

Gastrointestinal perforations are rare, but severe, complications in endoscopic procedures and they have traditionally been treated through surgery. Endoscopic perforation treatment has been achieved through the use of clips. However, all clips have limitations with respect to the amount of tissue they can hold together, the number of clips that can be used, and their usefulness in inflamed tissue. The Over-The-Scope-Clip (OTSC) system (Over-TheScope-Clip, Tübingen, Germany) is a recently developed device in which the clip is mounted on the endoscope. This clip grabs large quantities of tissue and closes the lesion until it heals. We present herein the cases of 5 patients with iatrogenic gastrointestinal perforation treated with the OTSC system. Three of the patients were women and 2 were men and they were between 52-80 years of age. Diagnoses were cholangiocarcinoma (n = 1), rectal cancer (n = 1), and pancreatic tumor (n = 3). The perforations resulted from colonoscopy (n = 1) and endoscopic ultrasound (n = 4) and were located at the rectosigmoid junction (n = 1), gastric antrum (n = 1), duodenal bulb (n = 2), and the posterior wall of the stomach (n = 1). They had a diameter of 5 mm (n = 1) and 10 mm (n = 4). An 11-mm type ‘‘t’’ OTSC was placed in all the cases. Adequate OTSC placement in the 4 patients with upper gastrointestinal perforation was confirmed through the instillation of contrast medium under fluoroscopic control. The patient with duodenal perforation underwent surgery due to the persistence of abdominal pain. During that surgery hermetic closure of the perforation was confirmed, but the OTSC was removed and replaced with a double suture line. In the patient with the perforation at the rectosigmoid junction, tissue friability secondary to radiotherapy caused a small tear at one end of the OTSC and closure was completed by the placement of a hemostatic clip. In addition, the patient presented with massive pneumoperitoneum that was managed through a percutaneous, 14-gauge needle puncture. The 5 patients began oral liquid diet 3 days after the perforation and were released from the hospital between 5-8 days after the incident. The OTSC system has been shown to be effective in the treatment of gastric, duodenal, and colonic perforations after endoscopy. Treatment was successful in our patients because perforation size was 10 mm or smaller (Figures 1 and 2). Perforations up to 15 mm can be closed using the OTSC system and larger defects can be closed using 2 OTSCs or one OTSC and a hemostatic clip, as was the case in our patient with the perforation at the rectosigmoid junction.