Application of the OTSC System for the Closure of Fistulas, Anastomosal Leakages and Perforations within the Gastrointestinal Tract

Until recently there has been no technique available which reproducibly and safely allowed endoscopic closures of penetrating defects within the digestive tract. With the new over the scope clipping system (OTSC system (R)), which regarding design and function is similar to a bear-trap, a method is available for the endoscopic closure of fistulas and perforations. Here, we present a series of 10 patients, in whom different penetrating defects within the digestive tract could be closed in 9 of 10 cases successfully by the OTSC system (R): fistulas (esophagotracheal, esophagopleural, gastrocutaneous and colovesical), perforations (after mucosectomy, after papillotomy and PEG misplacement) and anastomosal leakages (after gastrotomy and gastrectomy). In another case we demonstrate our first experience with the OTSC system (R) for the prevention of perforations during deep endoscopic R0 resection of a T1(sm1)G1 sigmoideal cancer after initial R1 resection.