AIM:To evaluate the outcome of over-the-scope-clip system(OTSC)for endoscopic treatment of various indications in daily clinical practice in Switzerland.METHODS:This prospective,consecutive case series was conducted a...AIM:To evaluate the outcome of over-the-scope-clip system(OTSC)for endoscopic treatment of various indications in daily clinical practice in Switzerland.METHODS:This prospective,consecutive case series was conducted at a tertiary care hospital from September 2010 to January 2014.Indications for OTSC application were fistulae,anastomotic leakage,perforation,unroofed submucosal lesion for biopsy,refractory bleeding,and stent fixation in the gastrointestinal(GI)tract.Primary technical success was defined as the adequate deployment of the OTSC on the target lesion.Clinical success was defined as resolution of the problem;for instance,no requirement for surgery or further endoscopic intervention.In cases of recurrence,retreatment of a lesion with a second intervention was possible.Complications were classified into those related to sedation,endoscopy,or deployment of the clip.RESULTS:A total of 28 OTSC system applications werecarried out in 21 patients[median age 64 years(range42-85),33%females].The main indications were fistulae(52%),mostly after percutaneous endoscopic gastrostomy tube removal,and anastomotic leakage after GI surgery(29%).Further indications were unroofed submucosal lesions after biopsy,upper gastrointestinal bleeding,or esophageal stent fixation.The OTSC treatments were applied either in the upper(48%)or lower(52%)GI tract.The mean lesion size was 8 mm(range:2-20 mm).Primary technical success and clinical success rates were 85%and 67%,respectively.In53%of cases,the suction method was used without accessories(e.g.,twin grasper or tissue anchor).No endoscopy-related or OTSC-related complications were observed.CONCLUSION:OTSC is a useful tool for endoscopic closure of various GI lesions,including fistulae and leakages.Future randomized prospective multicenter trials are warranted.展开更多
Gastrointestinal (GI) defects such as fistulas and leaks can be potentially closed endoscopically using hemo-clips and loops. However, hemoclips may not allow for closure of large defects and they do not exert enough ...Gastrointestinal (GI) defects such as fistulas and leaks can be potentially closed endoscopically using hemo-clips and loops. However, hemoclips may not allow for closure of large defects and they do not exert enough tensile force to keep fibrotic defects larger than 5 mm approximated. Herein we present a case of successful endoscopic closure of a gastrocolic fistula in a severely malnourished patient with complex post-surgical upper GI anatomy. We strongly believe that this device is a major breakthrough for the management of various types of discontinuity defects or fistulas. In addition, we show the usefulness of placing a direct jejunostomy using the double balloon enteroscopy (DBE) technique during the same procedure. The concept of providing direct jejunal feedings while allowing for upper gas-trointestinal bowel rest to promote the healing of the minimally invasive endoscopic operation is novel. Thus, our case is unique and exemplifies the utility of mini-mally invasive endoscopic endoluminal surgery.展开更多
文摘AIM:To evaluate the outcome of over-the-scope-clip system(OTSC)for endoscopic treatment of various indications in daily clinical practice in Switzerland.METHODS:This prospective,consecutive case series was conducted at a tertiary care hospital from September 2010 to January 2014.Indications for OTSC application were fistulae,anastomotic leakage,perforation,unroofed submucosal lesion for biopsy,refractory bleeding,and stent fixation in the gastrointestinal(GI)tract.Primary technical success was defined as the adequate deployment of the OTSC on the target lesion.Clinical success was defined as resolution of the problem;for instance,no requirement for surgery or further endoscopic intervention.In cases of recurrence,retreatment of a lesion with a second intervention was possible.Complications were classified into those related to sedation,endoscopy,or deployment of the clip.RESULTS:A total of 28 OTSC system applications werecarried out in 21 patients[median age 64 years(range42-85),33%females].The main indications were fistulae(52%),mostly after percutaneous endoscopic gastrostomy tube removal,and anastomotic leakage after GI surgery(29%).Further indications were unroofed submucosal lesions after biopsy,upper gastrointestinal bleeding,or esophageal stent fixation.The OTSC treatments were applied either in the upper(48%)or lower(52%)GI tract.The mean lesion size was 8 mm(range:2-20 mm).Primary technical success and clinical success rates were 85%and 67%,respectively.In53%of cases,the suction method was used without accessories(e.g.,twin grasper or tissue anchor).No endoscopy-related or OTSC-related complications were observed.CONCLUSION:OTSC is a useful tool for endoscopic closure of various GI lesions,including fistulae and leakages.Future randomized prospective multicenter trials are warranted.
文摘Gastrointestinal (GI) defects such as fistulas and leaks can be potentially closed endoscopically using hemo-clips and loops. However, hemoclips may not allow for closure of large defects and they do not exert enough tensile force to keep fibrotic defects larger than 5 mm approximated. Herein we present a case of successful endoscopic closure of a gastrocolic fistula in a severely malnourished patient with complex post-surgical upper GI anatomy. We strongly believe that this device is a major breakthrough for the management of various types of discontinuity defects or fistulas. In addition, we show the usefulness of placing a direct jejunostomy using the double balloon enteroscopy (DBE) technique during the same procedure. The concept of providing direct jejunal feedings while allowing for upper gas-trointestinal bowel rest to promote the healing of the minimally invasive endoscopic operation is novel. Thus, our case is unique and exemplifies the utility of mini-mally invasive endoscopic endoluminal surgery.
文摘根据甘薯苗栽植的农艺要求,设计了一种带夹式甘薯苗移栽机。介绍了移栽机的总体结构,以及主要工作部件送苗装置、插秧四连杆机构、夹苗爪的设计原理。设计了插秧四连杆机构,利用Mat Lab多元优化函数求出四杆机构的各个参数,并在Solid Works motion中进行了轨迹仿真。对甘薯苗进行了压缩实验,根据甘薯苗的力学特性设计了夹苗爪,保证苗爪可以在不伤苗的情况下将苗插入土壤。该研究为甘薯栽植机械创新研发提供了参考。
