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Over-the-Scope-Clips Can Be Fired Safely Over a Guidewire: Proof of Concept in an Ex-Vivo Porcine Model

BACKGROUND AND OBJECTIVES: To assist in achieving optimal position when deploying over-the-scope (OTS)-clips, the concept of cannulating the defect with a guidewire, backloading the endoscope onto the wire, and firing the OTS-clip over the wire with subsequent wire removal has been demonstrated. The...

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Autores principales: DeLong, Colin G., Liu, Alexander T., Winder, Joshua S., Pauli, Eric M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Society of Laparoendoscopic Surgeons 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9913066/
https://www.ncbi.nlm.nih.gov/pubmed/36818768
http://dx.doi.org/10.4293/JSLS.2022.00069
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author DeLong, Colin G.
Liu, Alexander T.
Winder, Joshua S.
Pauli, Eric M.
author_facet DeLong, Colin G.
Liu, Alexander T.
Winder, Joshua S.
Pauli, Eric M.
author_sort DeLong, Colin G.
collection PubMed
description BACKGROUND AND OBJECTIVES: To assist in achieving optimal position when deploying over-the-scope (OTS)-clips, the concept of cannulating the defect with a guidewire, backloading the endoscope onto the wire, and firing the OTS-clip over the wire with subsequent wire removal has been demonstrated. The safety of this technique has not been evaluated. METHODS: An ex-vivo porcine foregut model was utilized. Biopsy punches were used to create 3-mm diameter full-thickness gastrointestinal tract defects through which a guidewire was threaded. An endoscope was backloaded over the wire and OTS-clips (OVESCO, Tuebingen, Germany) were fired over the mucosal defect and wire. The wire was removed through the endoscope and the removal difficulty was graded using a Likert scale. This process was repeated for each unique combination of nine OTS-clip types, two wire types, four wire angles, and three tissue types. Statistical analysis included t test and ANOVA. RESULTS: Two hundred sixteen OTS-clip firings with wire removal attempts were performed with the following Likert score breakdown: 1 – No difficulty (80.6%), 2 – mild difficulty (16.2%), 3 – moderate difficulty (2.3%), 4 – extreme difficulty (0.9%), and 5 – unable to remove (0%). Statistically significant differences were noted in removal difficulty between OTS-clip sizes (p < 0.05). No differences were identified between clip teeth types, wire types, tissue types, and wire angles (p > 0.05). CONCLUSION: In this ex-vivo model, the guidewire was successfully removed through the endoscope in all cases. This technique can be employed to facilitate OTS-clip closure of gastrointestinal tract defects, but further study is indicated before wide clinical implementation.
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spelling pubmed-99130662023-02-16 Over-the-Scope-Clips Can Be Fired Safely Over a Guidewire: Proof of Concept in an Ex-Vivo Porcine Model DeLong, Colin G. Liu, Alexander T. Winder, Joshua S. Pauli, Eric M. JSLS Research Article BACKGROUND AND OBJECTIVES: To assist in achieving optimal position when deploying over-the-scope (OTS)-clips, the concept of cannulating the defect with a guidewire, backloading the endoscope onto the wire, and firing the OTS-clip over the wire with subsequent wire removal has been demonstrated. The safety of this technique has not been evaluated. METHODS: An ex-vivo porcine foregut model was utilized. Biopsy punches were used to create 3-mm diameter full-thickness gastrointestinal tract defects through which a guidewire was threaded. An endoscope was backloaded over the wire and OTS-clips (OVESCO, Tuebingen, Germany) were fired over the mucosal defect and wire. The wire was removed through the endoscope and the removal difficulty was graded using a Likert scale. This process was repeated for each unique combination of nine OTS-clip types, two wire types, four wire angles, and three tissue types. Statistical analysis included t test and ANOVA. RESULTS: Two hundred sixteen OTS-clip firings with wire removal attempts were performed with the following Likert score breakdown: 1 – No difficulty (80.6%), 2 – mild difficulty (16.2%), 3 – moderate difficulty (2.3%), 4 – extreme difficulty (0.9%), and 5 – unable to remove (0%). Statistically significant differences were noted in removal difficulty between OTS-clip sizes (p < 0.05). No differences were identified between clip teeth types, wire types, tissue types, and wire angles (p > 0.05). CONCLUSION: In this ex-vivo model, the guidewire was successfully removed through the endoscope in all cases. This technique can be employed to facilitate OTS-clip closure of gastrointestinal tract defects, but further study is indicated before wide clinical implementation. Society of Laparoendoscopic Surgeons 2023 /pmc/articles/PMC9913066/ /pubmed/36818768 http://dx.doi.org/10.4293/JSLS.2022.00069 Text en © 2023 by SLS, Society of Laparoscopic & Robotic Surgeons. https://creativecommons.org/licenses/by-nc-nd/3.0/us/This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License (http://creativecommons.org/licenses/by-nc-nd/3.0/us/ (https://creativecommons.org/licenses/by-nc-nd/3.0/us/) ), which permits for noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited and is not altered in any way.
spellingShingle Research Article
DeLong, Colin G.
Liu, Alexander T.
Winder, Joshua S.
Pauli, Eric M.
Over-the-Scope-Clips Can Be Fired Safely Over a Guidewire: Proof of Concept in an Ex-Vivo Porcine Model
title Over-the-Scope-Clips Can Be Fired Safely Over a Guidewire: Proof of Concept in an Ex-Vivo Porcine Model
title_full Over-the-Scope-Clips Can Be Fired Safely Over a Guidewire: Proof of Concept in an Ex-Vivo Porcine Model
title_fullStr Over-the-Scope-Clips Can Be Fired Safely Over a Guidewire: Proof of Concept in an Ex-Vivo Porcine Model
title_full_unstemmed Over-the-Scope-Clips Can Be Fired Safely Over a Guidewire: Proof of Concept in an Ex-Vivo Porcine Model
title_short Over-the-Scope-Clips Can Be Fired Safely Over a Guidewire: Proof of Concept in an Ex-Vivo Porcine Model
title_sort over-the-scope-clips can be fired safely over a guidewire: proof of concept in an ex-vivo porcine model
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9913066/
https://www.ncbi.nlm.nih.gov/pubmed/36818768
http://dx.doi.org/10.4293/JSLS.2022.00069
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