The over-the-scope clipping system for treatment of chronic coloenteric fistula: a case report
© Radziunas et al. 2015
Received: 28 February 2015
Accepted: 15 June 2015
Published: 17 July 2015
Anastomotic leak in colorectal surgery is not very unusual. The over-the-scope clipping (OTSC) system (Ovesco), which was originally developed to treat intestinal perforation and was tested with animals, might be the choice for the patient. We presented the case of a 63-year-old man with chronic coloenteric fistula. Conservative treatment was unsuccessful. The orifice was then closed with two subsequent clips, and the patient recovered well. To our knowledge, this is the first successful case of coloenteric fistula treatment with Ovesco.
Anastomotic leakage after a colorectal resection is not very unusual complication (3–21 %), and it has a significant mortality (6–22 %) . The best treatment for the patient is total parenteral nutrition or a diverting ileostomy for 2–3 months with subsequent reversal of ileostomy only when a radiological contrast study shows that the fistula has healed .
About 8 years ago, an over-the-scope clip system, called OTSC (Ovesco Endoscopy, Tubingen, Germany), appeared on the market. It was first tested in animal models and the treating of lesions or bleeding of the gastrointestinal tract [3, 4].
Here, we are presenting the case of a male patient, with a chronic coloenteric fistula after colorectal cancer surgery which was successfully treated by endoscopy. To our knowledge, this is the first successful case of coloenteric fistula treatment with Ovesco.
A 63-year-old male was admitted to our institute complaining of defecation with blood. Cancer in the middle part of rectal ampulla was diagnosed. After examination and multidisciplinary team consultation, neoadjuvant radiotherapy was started.
The OTSC system is a technique that enables the closure of gastrointestinal defects (perforation sites, leaks, fistulas) and may stop severe bleeding from large lesions of the gastrointestinal tract. For patients who develop a leak after colorectal surgery, treatment can be long and sometimes complicated. A defunctioning ileostomy is not effective in some cases. After the OTSC system application, the patient can be treated at home as was the case with our patient. A successful closure of the leak or fistula is possible when no extraluminal abscess is present . In our case, we had a cavity (previous sinus or abscess) that drained into the small bowel, thereby forming the coloenteric fistula. This allowed us to succeed with a fistula closure, as the cavity could drain into the small bowel.
In summary, the application of OTSC appears to be useful in the endoscopic management of colorectal postsurgical fistulas. Further prospective clinical studies are needed to confirm the value and the efficacy of this clipping device.
Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
- Blumetti J, Chaudhry V, Cintron JR, Park JJ, Marecik S, Harrison JL, et al. Management of anastomotic leak: lessons learned from a large colon and rectal surgery training program. World J Surg. 2014;38:985–91.PubMedView ArticleGoogle Scholar
- Kobayashi H, Kikuchi A, Okazaki S, Ishiguro M, Ishikawa T, Iida S, et al. Over-the-scope-clipping system for anastomotic leak after colorectal surgery: report of two cases. World J Gastroenterol. 2014;20:7984–7.PubMed CentralPubMedView ArticleGoogle Scholar
- Mangiavillano B, Pisani A, Viaggi P, Arena M, Opocher E, Mangano M, et al. Endoscopic sealing of a rectovesical fistula with a combination of an over the scope clip and cyano-acrylate injection. J Gastrointest Oncol. 2010;1:122–4.PubMed CentralPubMedGoogle Scholar
- Schurr MO, Hartmann C, Ho CN, Fleisch C, Kirschniak A. An over-the-scope clip (OTSC) system for closure of iatrogenic colon perforations: results of an experimental survival study in pigs. Endoscopy. 2008;40:584–8.PubMedView ArticleGoogle Scholar
- Kirschniak A, Kratt T, Stüker D, Braun A, Schurr MO, Konigsrainer A. A new endoscopic over-the-scope clip system for treatment of lesions and bleeding in the GI tract: first clinical experiences. Gastrointest Endosc. 2007;66:162–7.PubMedView ArticleGoogle Scholar
- Arezzo A, Verra M, Reddavid R, Cravero F, Bonino MA, Morino M. Efficacy of the over-the-scope clip (OTSC) for treatment of colorectal postsurgical leaks and fistulas. Surg Endosc. 2012;26:3330–3.PubMedView ArticleGoogle Scholar
- Weiland T, Fehlker M, Gottwald T, Schurr MO. Performance of the OTSC System in the endoscopic closure of iatrogenic gastrointestinal perforations: a systematic review. Surg Endosc. 2013;27:2258–74.PubMedView ArticleGoogle Scholar
- Albert JG, Friedrich-Rust M, Woeste G, Strey C, Bechstein WO, Zeuzem S, et al. Benefit of a clipping device in use in intestinal bleeding and intestinal leakage. Gastrointest Endosc. 2011;2:389–97.View ArticleGoogle Scholar
- Sulz MC, Bertolini R, Frei R, Semadeni GM, Borovicka J, Meyenberger C. Multipurpose use of the over-the-scope-clip system (“Bear claw”) in the gastrointestinal tract: Swiss experience in a tertiary center. World J Gastroenterol. 2014;20:16287–92.PubMed CentralPubMedGoogle Scholar
- Manta R, Manno M, Bertani H, Barbera C, Pigo F, Mirante V, et al. Endoscopic treatment of gastrointestinal fistulas using an over-the-scope clip (OTSC) device: case series from a tertiary referral center. Endoscopy. 2011;43:545–8.PubMedView ArticleGoogle Scholar
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.