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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Jan 10, 2016; 8(1): 13-22
Published online Jan 10, 2016. doi: 10.4253/wjge.v8.i1.13
Role of endoscopic clipping in the treatment of oesophageal perforations
György Lázár, Attila Paszt, Eszter Mán
György Lázár, Attila Paszt, Eszter Mán, Department of Surgery, University of Szeged, Szeged 6720, Hungary
Author contributions: Lázár G wrote the article and analyzed the data; Paszt A and Mán E collected and analyzed the data and created the tables.
Conflict-of-interest statement: The authors declare no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: György Lázár, MD, PhD, Head, Department of Surgery, University of Szeged, H-6720 Szeged, Szőkefalvi-Nagy Béla u. 6., Szeged 6720, Hungary. gylazar@gmail.com
Telephone: +36-62-545701 Fax: +36-62-545701
Received: July 28, 2015
Peer-review started: July 30, 2015
First decision: September 14, 2015
Revised: September 25, 2015
Accepted: November 10, 2015
Article in press: November 11, 2015
Published online: January 10, 2016
Processing time: 163 Days and 18.8 Hours
Abstract

With advances in endoscopic technologies, endoscopic clips have been used widely and successfully in the treatment of various types of oesophageal perforations, anastomosis leakages and fistulas. Our aim was to summarize the experience with two types of clips: The through-the-scope (TTS) clip and the over-the-scope clip (OTSC). We summarized the results of oesophageal perforation closure with endoscopic clips. We processed the data from 38 articles and 127 patients using PubMed search. Based on evidence thus far, it can be stated that both clips can be used in the treatment of early (< 24 h), iatrogenic, spontaneous oesophageal perforations in the case of limited injury or contamination. TTS clips are efficacious in the treatment of 10 mm lesions, while bigger (< 20 mm) lesions can be treated successfully with OTSC clips, whose effectiveness is similar to that of surgical treatment. However, the clinical success rate is significantly lower in the case of fistulas and in the treatment of anastomosis insufficiency. Tough prospective randomized multicentre trials, which produce the largest amount of evidence, are still missing. Based on experience so far, endoscopic clips represent a possible therapeutic alternative to surgery in the treatment of oesophageal perforations under well-defined conditions.

Keywords: Oesophageal perforation; Endoscopic clipping; Upper gastrointestinal perforation; Endoscopy; Over-the-scope clip

Core tip: With advances in endoscopic technologies, endoscopic clips have been used successfully in the treatment of various types of oesophageal perforations, anastomosis leakages and fistulas. We summarized the results of oesophageal perforation closure with endoscopic clips [the through-the-scope (TTS) clip and the over-the-scope clip (OTSC)]. We processed the data from 38 articles and 127 patients using PubMed search. Based on the evidence, TTS clips are efficacious in the treatment of 10 mm lesions, while bigger (< 20 mm) lesions can be treated successfully with OTSC clips. Based on experience so far, endoscopic clips represent a possible therapeutic alternative to surgery in the treatment of oesophageal perforations under well-defined conditions.