Ulus Travma Acil Cerrahi Derg. 2021; 27(1): 146-150 | DOI: 10.14744/tjtes.2020.15719

Þiddetli gastrointestinal kanama, kaçak ve perforasyonlar için over-the-scope klip uygulamalarý: Tek merkez deneyimi

Ali Kocataþ, Erkan Somuncu, Mehmet Abdussamet Bozkurt
Saðlýk Bilimleri Üniversitesi, Kanuni Sultan Süleyman Eðitim ve Araþtýrma Hastanesi, Genel Cerrahi Kliniði, Ýstanbul

AMAÇ: Kapsam dýþý klips (OTSC) cihazlarý artýk endoskopistler tarafýndan gastrointestinal kanama, perforasyon veya sýzýntý için yaygýn olarak kullanýlmaktadýr. Bu çalýþmanýn amacý, bu tekniðin terapötik baþarý oranýný incelemekti.
GEREÇ VE YÖNTEM: Bu çalýþma tek merkezli ve geriye dönük olarak yapýldý. Çalýþmaya gastrointestinal kanamasý, sýzýntýsý veya perforasyonu olan toplam 23 hasta alýndý. Prosedür deneyimli endoskopist tarafýndan gerçekleþtirildi.
BULGULAR: Üst gastrointestinal sistem defekti olan hastalarýn altýsýnda perforasyon, bir olguda anastomoz kaçaðý vardý. Sekiz hastada alt gastrointestinal kanalda perforasyon vardý ve iki olgu anastomoz kaçaðý vardý. Sadece altý hastada kanama tespit edildi ve tümü üst gastrointestinal kanama idi. Anastomoz sýzýntýlarý, perforasyonlar ve kanama OTSC ve ek prosedürlerle tedavi edildi. Tek baþýna OTSC kýrpmanýn baþarý oraný %56.5 iken, ek terapötik prosedürlerle (klemp, stent, skleroterapi) baþarý oraný %86.9’du. Kanama, perforasyon ve anastomoz kaçaðý kategorilerine göre yapýlan analizler, klip uygulamasýnýn kanamadaki baþarý oranýnýn perforasyon veya anastomoz kaçaðýna göre anlamlý derecede yüksek olduðunu ortaya koydu (p=0.002). Hastanede ortalama kalýþ süresi beþ gündü (min-maks: 2–30 gün). OTSC prosedürü ile iliþkili herhangi bir komplikasyon yoktu.
TARTIÞMA: OTSC, gastrointestinal kanama, perforasyon veya anastomoz sýzýntýsýnýn yönetimi için güvenli ve etkili bir yöntemdir.

Anahtar Kelimeler: Gastrointestinal kaçak, kanama; kapsam dýþý klip; perforasyon.

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Over-the-scope clip application for severe gastrointestinal bleeding, leak, or perforation: A single-center experience

Ali Kocataþ, Erkan Somuncu, Mehmet Abdussamet Bozkurt
Department of General Surgery, University of Health Sciences, Kanuni Sultan Suleyman Training and Research Hospital, Ýstanbul-Turkey

BACKGROUND: Over-the-scope clip (OTSC) devices are now widely used by endoscopists for gastrointestinal bleeding, perforation, or leakage. The present study aims to examine the therapeutic success rate of this technique.
METHODS: This was a single-center, retrospective study. In this study, 23 patients with gastrointestinal bleeding, leakage, or perforation were included. The procedure was performed by an experienced endoscopist.
RESULTS: Of the patients with an upper gastrointestinal tract defect, six had a perforation and there was one case of anastomosis leakage. Eight patients had a perforation in the lower gastrointestinal tract, and there were two cases of anastomosis leakage. Bleeding was detected in only six patients and all of them were upper gastrointestinal bleeding. Anastomosis leaks, perforations, and bleeding were treated with OTSC and additional procedures. The success rate of OTSC clipping alone was 56.5%. However, the success rate was 86.9% with additional therapeutic procedures (clamp, stent, sclerotherapy). Analysis according to categories of bleeding, perforation, and anastomosis leak revealed that the success rate of the clip application in bleeding was significantly higher than that of perforation or anastomosis leak (p=0.002). The median length of stay in the hospital was five days (min-max: 2–30 days). There were no complications associated with the OTSC procedure.
CONCLUSION: OTSC is a safe and effective method for the management of gastrointestinal bleeding, perforation, or anastomosis leak.

Keywords: Bleeding, gastrointestinal leak; over-the-scope clip; perforation.

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