Endoscopy 2019; 51(04): S194
DOI: 10.1055/s-0039-1681745
ESGE Days 2019 ePoster podium presentations
Saturday, April 6, 2019 14:00 – 14:30: Leaks 2 ePoster Podium 5
Georg Thieme Verlag KG Stuttgart · New York

COMBINATION ENDOSCOPIC THERAPY USING ENDOSPONGE AND OVER-THE-SCOPE-CLIP FOR THE THERAPY OF COMPLEX GASTROINTESTINAL LEAKS AND DEHISCENCES

A Martinez-Alcala
1   Gastroenterologie, Frankenwald Klinik, Kronach, Germany
,
JP Gutierrez
2   Gastroenterology, Basil Hirschowitz Endoscopic Center of Excellence, Birmingham, United States
,
MA D'Assuncao
2   Gastroenterology, Basil Hirschowitz Endoscopic Center of Excellence, Birmingham, United States
,
PT Kroener
3   Mayo Clinic, Jacksonville, United States
,
K Mönkemüller
1   Gastroenterologie, Frankenwald Klinik, Kronach, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

Also available at
 

Aims:

To evaluate the success, safety and complications rates of an endoscopic approach using sponge and over-the-scope clips to close large endoluminal GI defects.

Methods:

Retrospective, observational study at two institutions during a 24-months period. The following over-the-scope clips were used preferentially 12/6 t, and 12/6gc and 14/6 t. The sponge (Braun Melsungen, Germany) was used as manufactured or adapted to the size of the defect.

Results:

During the study period we treated a total of 13 patients (9 male, 4 female, mean age 58.9 years; range 38 to 73) with large fistulae or perforations. The mean ASA socre was 3.5, range 3 – 4. Seven patients were critically ill at the time of consultation, with large perforation or intrabadominal abscess. The etiology of the GI defects involving the esophagus (n = 3), stomach (n = 3), small bowel N = 2) and colon (n = 5), including Boerhaave's syndrome n = 2, leak after gastric sleeve n = 2, colorectal anastomotic leak n = 5, lung abscess with tracheoesophageal fistula (n = 1), combined retroperitoneal and pleural abscess (n = 1), enterocutaneous fistula in Crohn's (n = 1), radiation-induced rectovesical fistula (n = 1). The defects were treated sequentially by endoscopic lavage and debridement, followed by insertion of sponge. Once the cavity decreased in size the sponge was exchanged or removed and the smaller diameter defect was closed using one or more over-the-scope clips. The mean number of procedures was 3, range 2 – 5. Successful closure of the GI defect and resolution of the abscess was achieved in eight patients (61%). There were no adverse events related.

Conclusions:

The use of combination sponge and over-the-scope clip appears promising for the treatment of complex GI endoluminal defects, especially when patients are poor surgical candidates and are critically ill. In up to 60% of patients the therapy was successful, suggesting that this approach should be added to the armamentarium of the advanced endoscopist.