OVER THE SCOPE CLİP (OTSC) İLE BAŞARISIZ KOLON PERFORASYONU KAPATMA GİRİŞİMİ: OLGU SUNUMU

Giriş: Kolonoskopik perforasyon, alt gastrointestinal sistem görüntülemeleri sırasında görülebilecek en ciddi komplikasyonlardan bir tanesidir. Gastrointestinal sistem perforasyonu, hava kaçağına, gastrik veya intestinal sıvıların sızmasına, safra veya gaitanın batın içine sızması ile peritonit, pnömoperitonyum ve sepsis gibi ciddi durumlara neden olabilir. İatrojenik perforasyon yönetimi ve güvenli endoskopik kapatma teknikleri büyük ilgi görmektedir. Gastrointestinal perforasyonlarının kapatılması için over the scope clips (OTSC)'lerin through the scope clips(TTS)’e göre üstün olduğu bildirilmektedir. Biz bu yazıda sigmoid kolon perforasyonu nedeni ile OTSC uygulanan ancak başarısız olması nedeni ile TTS ile onarım sağlanan vakamızı sunmayı amaçladık.Olgu: 73 yaş kadın hastada kolonoskopi işlemi sırasında sigmoid kolon ortalarında kolonoskopi ilişkili perforasyon gelişmesi nedeni ile OTSC uygulandı ve defekt kapatıldı. Ancak birkaç dakika sonra yapılan kontrol kolonoskopide OTSC klipsin tuttuğu dokuyu bıraktığı görülmesi nedeni ile defekt 5 adet TTS klips ile kapatıldı. Tartışma: OTSC sistemi, gastrointestinal kanama, perforasyon, anastomoz kaçağı ve fistül tedavisinde başarıyla kullanılabilen yeni bir tekniktir. OTSC ile genel başarı oranının, iatrojenik gastrointestinal perforasyonların kapatılmasında % 75 ila % 100 arasında olduğu bildirilmekle beraber, başarılı OTSC uygulaması sonrası erken dönemde doku gerilimine bağlı olarak klipsin dokuyu bırakabileceği akılda tutulmalıdır.

Anahtar Kelimeler:

KOLONOSKOPİ, PERFORASYON, OTSC, TTS

FAİLED ATTEMPT AT COLONİC PERFORATİON CLOSURE WİTH OVER THE SCOPE CLİP (OTSC): CASE REPORT

İntroduction: Colonoscopic perforation is one of the most serious complications during lower gastrointestinal system imaging. Perforation of the gastrointestinal tract can lead to air leakage, leakage of gastric or intestinal fluids, leakage of bile or feces into the abdomen, and serious conditions such as peritonitis, pneumoperitonium and sepsis. Iatrogenic perforation management and safe endoscopic closure techniques are of great interest. The superiority of over the scope clips(OTSC) over through the scope clips (TTS) for closure of gastrointestinal perforations has been reported.In this article, we aimed to present our case who underwent OTSC for sigmoid colon perforation but failed to repair with 5 TTS clip.Case Report: A 73-year-old female patient underwent OTSC because of colonoscopy-related perforation in the middle of the sigmoid colon during the colonoscopy procedure and the defect was closed. However, after 5 minutes, the control colonoscopy revealed that the OTSC clip was releasing the tissue retained and the defect was closed with conventional clips (TTS). Discussion: The OTSC system is a novel technique that can be used successfully in the treatment of gastrointestinal bleeding, perforation, anastomotic leakage and fistula. Although the overall success rate with OTSC is reported to be between 75% and 100% in the closure of iatrogenic gastrointestinal perforations, it should be kept in mind that after successful OTSC application, the clip may release the tissue due to tissue tension in the early period.

Keywords:

COLONOSCOPY, PERFORATION, OTSC, TTS,

PDF

___

1. Khater, S. et al. End Int Open OTSC Perforaciones Colónicas 2017. 389–394 (2017).
2. Lohsiriwat, V. Colonoscopic perforation: incidence, risk factors, management and outcome. World J. Gastroenterol. 16, 425–30 (2010).
3. MANGIAVILLANO, B., VIAGGI, P. & MASCI, E. Endoscopic closure of acute iatrogenic perforations during diagnostic and therapeutic endoscopy in the gastrointestinal tract using metallic clips: A literature review. J. Dig. Dis. 11, 12–18 (2010).
4. Baron, T. H. et al. A comprehensive approach to the management of acute endoscopic perforations (with videos). Gastrointest. Endosc. 76, 838–59 (2012).
5. von Renteln, D. et al. Endoscopic closure of large colonic perforations using an over-the-scope clip: a randomized controlled porcine study. Endoscopy 41, 481–6 (2009).
6. Matthes, K., Jung, Y., Kato, M., Gromski, M. A. & Chuttani, R. Efficacy of full-thickness GI perforation closure with a novel over-the-scope clip application device: an animal study. Gastrointest. Endosc. 74, 1369–75 (2011).
7. Weiland, T., Fehlker, M., Gottwald, T. & Schurr, M. O. Performance of the OTSC System in the endoscopic closure of iatrogenic gastrointestinal perforations: a systematic review. Surg. Endosc. 27, 2258–2274 (2013).
8. Zimmer, V. & Exner, S. “Tulip bundle rescue” troubleshooting over-the-scope clip (OTSC) failure in ERCP-related duodenal perforation (Stapfer I). Dig. Liver Dis. 50, 514 (2018).
9. Fischer, A. & Richter-Schrag, H. J. Over-the-scope clip (OTSC)-induced colonic obstruction necessitating sigmoid resection. Endoscopy 47, E157–E158 (2015).
10. Brodie, M., Gupta, N. & Jonnalagadda, S. Failed attempt at duodenal perforation closure with over-the-scope clip. Gastrointest. Endosc. 81, 1271–1272 (2015).