TY  - JOUR
A1  - Farnik, Harald
A1  - Driller, Marlene
A1  - Kratt, Thomas
A1  - Schmidt, Carsten
A1  - Fähndrich, Martin
A1  - Filmann, Natalie
A1  - Königsrainer, Alfred
A1  - Stallmach, Andreas
A1  - Heike, Michael
A1  - Bechstein, Wolf Otto
A1  - Zeuzem, Stefan
A1  - Albert, Jörg Gerhard
T1  - Indication for "over the scope" (OTS)-Clip vs. covered self-expanding metal stent (cSEMS) is unequal in upper gastrointestinal leakage : results from a retrospective head-to-head comparison
T2  - PLoS One
N2  - Background: Intestinal perforation or leakage increases morbidity and mortality of surgical and endoscopic interventions. We identified criteria for use of full-covered, extractable self-expanding metal stents (cSEMS) vs. "Over the scope"-clips (OTSC) for leak closure.
Methods: Patients who underwent endoscopic treatment for postoperative leakage, endoscopic perforation, or spontaneous rupture of the upper gastrointestinal tract between 2006 and 2013 were identified at four tertiary endoscopic centers. Technical success, outcome (e.g. duration of hospitalization, in-hospital mortality), and complications were assessed and analyzed with respect to etiology, size and location of leakage.
Results: Of 106 patients (male: 75 (71%), female: 31 (29%); age (mean ± SD): 62.5 ± 1.3 years, 72 (69%) were treated by cSEMS and 34 (31%) by OTSC. For cSEMS vs. OTSC, mean treatment duration was 41.1 vs. 25 days, p<0.001, leakage size 10 (1-50) vs. 5 (1-30) mm (median (range)), and complications were observed in 68% vs. 8.8%, p<0.001, respectively. Clinical success for primary interventional treatment was observed in 29/72 (40%) vs. 24/34 (70%, p = 0.006), and clinical success at the end of follow-up was 46/72 (64%) vs. 29/34 (85%) for patients treated by cSEMS vs. OTSC; p = 0.04.
Conclusion: OTSC is preferred in small-sized lesions and in perforation caused by endoscopic interventions, cSEMS in patients with concomitant local infection or abscess. cSEMS is associated with a higher frequency of complications. Therefore, OTSC might be preferred if technically feasible. Indication criteria for cSEMS vs. OTSC vary and might impede design of randomized studies.
Y1  - 2015
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/37061
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-370616
SN  - 1932-6203
N1  - Copyright: © 2015 Farnik et al. 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 author and source are credited
VL  - 10
IS  - (1): e0117483
PB  - PLoS
CY  - Lawrence, Kan.
ER  -