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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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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Society of Laparoendoscopic Surgeons
2023
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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. |
format | Online Article Text |
id | pubmed-9913066 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Society of Laparoendoscopic Surgeons |
record_format | MEDLINE/PubMed |
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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