Endoscopic Treatment of Various Gastrointestinal Tract Defects with an Over-the-Scope Clip: Case Series from a Tertiary Referral Hospital
A 47-year-old male patient who had undergone minigastric bypass for diabetes mellitus experienced anastomotic site leakage. Despite a successful surgical repair, he developed additional leakage at multiple sites, including a jejunocutaneous fistula. Furthermore, he developed a delayed allergic response to vicryl. We decided to use the OTSC system for fistula closure. Gastroduodenoscopy with the OTSC system was performed with fluoroscopic guidance with the patient under conscious sedation. A total of three fistulas were identified and successfully closed during three separate sessions, each with a single OTSC. The patient was discharged with no further complications.\nA 32-year-old woman underwent sleeve gastrectomy for morbid obesity. Two weeks after the gastrectomy, computed tomographic (CT) scans revealed a large intraperitoneal abscess due to anastomotic leakage at the esophagogastric junction. After percutaneous drainage of the abscess, we decided to use the OTSC system for primary closure. The fistula opening was approximately 10 mm wide. One OTSC was placed, successfully sealing the deficit, as confirmed by the introduction of gastrografin under fluoroscopy.\nA 56-year-old man presented with fever and abdominal\npain. He had been treated 2 months previously for necrotizing pancreatitis and a pancreatic pseudocyst, which was drained percutaneously. On admission, a colonopseudocystic fistula was detected by using contrast fluoroscopy. After identification of the fistula opening by using both indigo carmine dye and contrast, the OTSC system was used for primary closure of the fistula tract. A single t-type OTSC, with only suction applied, was used to completely seal the fistula. The fistula was completely healed after 5 days ().\nA 50-year-old man underwent endoscopic full-thickness gastric resection (EFTGR) for early gastric cancer. He had a history of chronic hepatitis B and had undergone transarterial chemoembolization for hepatoma. His tumor stage was T1bN0M0 according to endoscopic ultrasonography and abdominal CT findings. Although radical gastrectomy with nodal dissection is the standard treatment, we performed EFTGR with OTSC closure considering his comorbidities and surgical risk. After the EFTGR, the size of the gastric opening was approximately 30 mm. With laparoscopic guidance, we used an OTSC twin grasper to approximate the opposing margins of the opening and three t-type OTSCs for closure. Successful closure was confirmed by performing a leak test with indigo carmine dye and room air. Three days later, we performed an upper GI series with gastrografin. The seal at the opening was confirmed with the introduction of gastrografin under fluoroscopy. The patient was discharged 13 days later with no complications ().\nA 57-year-old man underwent endoscopic en bloc resection for a gastric subepithelial tumor (SET) involving the muscle layer. The preresection diagnosis was a leiomyoma or a GI stromal tumor. The 1.2-cm tumor was removed by performing conventional endoscopic mucosal resection with a standard endoscopic snare. However, after resection, the muscularis proper was exposed at the base of the tumor. Because of the possible risk of delayed perforation, we decided to use the OTSC to prevent perforation. We used the OTSC twin grasper to grasp both ends of the resection margin, then successfully closed the wound with a t-type OTSC. Two days later, we performed gastroduodenoscopy. The lesion was completely sealed by using the OTSC, and the patient was discharged the following day ().