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J Gastrointest Surg. 2012 Nov;16(11):2132-8. doi: 10.1007/s11605-012-1983-6. Epub 2012 Aug 18.

Over-the-scope clip application yields a high rate of closure in gastrointestinal perforations and may reduce emergency surgery.

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Department of Medicine I, Gastroenterology, University of Erlangen-Nuremberg, Ulmenweg 18, 91054 Erlangen, Germany.



Perforation of the gastrointestinal tract may cause various complications and may require emergency surgery, even in patients with significant comorbidities.


Seventeen consecutive patients with indication for surgery due to a visible gastrointestinal perforation were treated with OTSC application. In this study, cause of perforation, estimated size, location, rate of perforation closure, outcome and complications were reported.


In 11 of 17 patients (64.7 %), OTSC application resulted in permanent closure of perforations, thus avoiding surgery. All 11 successful cases had smaller perforation lengths (5.5 ± 1.9 mm, p < 0.02), widths (3.7 ± 0.9 mm) or area (21.1 ± 9.1 mm(2)), had vital margins of perforations and 1.1 ± 0.3 OTSC per patient were necessary. The six unsuccessful cases (35.3 %) showed larger perforation lengths (13.4 ± 8.8 mm, p < 0.02), widths (5 ± 4.5 mm) and area (97.6 ± 149 mm(2)), had necrotic or soft inflammatory margins and significantly more OTSC (2.3 ± 0.5, p = 0.018) were tried.


OTSC application yields a high rate of endoscopic perforation closure in patients with macroscopic gastrointestinal perforation, even in an emergency setting, representing an alternative to surgery, especially when the size of the lesion is not too large and when vital or solid perforation margins are expected.

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