{"title":"关闭方法，以防止在过线方法中使用多个过范围夹从穿孔中泄漏。","authors":"Makoto Kobayashi, Tatsuma Nomura, Motoyoshi Yano","doi":"10.1111/den.14984","DOIUrl":null,"url":null,"abstract":"<p>An over-the-scope clip (OTSC; Ovesco Endoscopy GmbH, Tuebingen, Germany) is a very useful device for the closure of perforations.<span><sup>1</sup></span> However, when multiple OTSCs are used in sequence for large perforations, the outer projections of the OTSCs create gaps. A reopenable clip-over-the-line method uses multiple clips. However, by pulling a thread, the gaps between clips are reduced.<span><sup>2, 3</sup></span> We have attempted to close perforations using multiple OTSCs in an over-the-line method (MOLM) (Figs 1, 2).</p><p>Two OTSCs were used for the closure of an artificial perforation in a resected porcine stomach. First, nylon thread was passed through the gap, between the first OTSC and hood, and ligated to the OTSC. Second, the first OTSC was attached to an endoscope with the thread facing inward and closure was undertaken from the edge of the perforation. Third, after the second OTSC was attached to the endoscope, the thread tied to the first OTSC was withdrawn from the endoscope tip into the working channel. The endoscope was inserted into the stomach. Finally, the thread was pulled until the two OTSCs came together and the remaining perforation was closed. Excess thread was cut by a Loop Cutter (Olympus, Tokyo, Japan) and the procedure was terminated. Observation by endoscopy from inside the lumen showed complete closure. Further pressure was then applied using water in the stomach but no leakage was observed. Even a 3 cm diameter defect could be closed in the same way from the edge with four OTSCs and a Twin Grasper (Ovesco Endoscopy GmbH) (Video S1).</p><p>By using a MOLM, it is possible to eliminate gaps between OTSCs and to provide strong and leak-free closures of large perforations.</p><p>Authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 5","pages":"558-559"},"PeriodicalIF":5.0000,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14984","citationCount":"0","resultStr":"{\"title\":\"Closure method to prevent leakages from perforations using multiple over-the-scope clips in an over-the-line method\",\"authors\":\"Makoto Kobayashi, Tatsuma Nomura, Motoyoshi Yano\",\"doi\":\"10.1111/den.14984\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p>An over-the-scope clip (OTSC; Ovesco Endoscopy GmbH, Tuebingen, Germany) is a very useful device for the closure of perforations.<span><sup>1</sup></span> However, when multiple OTSCs are used in sequence for large perforations, the outer projections of the OTSCs create gaps. A reopenable clip-over-the-line method uses multiple clips. However, by pulling a thread, the gaps between clips are reduced.<span><sup>2, 3</sup></span> We have attempted to close perforations using multiple OTSCs in an over-the-line method (MOLM) (Figs 1, 2).</p><p>Two OTSCs were used for the closure of an artificial perforation in a resected porcine stomach. First, nylon thread was passed through the gap, between the first OTSC and hood, and ligated to the OTSC. Second, the first OTSC was attached to an endoscope with the thread facing inward and closure was undertaken from the edge of the perforation. Third, after the second OTSC was attached to the endoscope, the thread tied to the first OTSC was withdrawn from the endoscope tip into the working channel. The endoscope was inserted into the stomach. Finally, the thread was pulled until the two OTSCs came together and the remaining perforation was closed. Excess thread was cut by a Loop Cutter (Olympus, Tokyo, Japan) and the procedure was terminated. Observation by endoscopy from inside the lumen showed complete closure. Further pressure was then applied using water in the stomach but no leakage was observed. Even a 3 cm diameter defect could be closed in the same way from the edge with four OTSCs and a Twin Grasper (Ovesco Endoscopy GmbH) (Video S1).</p><p>By using a MOLM, it is possible to eliminate gaps between OTSCs and to provide strong and leak-free closures of large perforations.</p><p>Authors declare no conflict of interest for this article.</p>\",\"PeriodicalId\":159,\"journal\":{\"name\":\"Digestive Endoscopy\",\"volume\":\"37 5\",\"pages\":\"558-559\"},\"PeriodicalIF\":5.0000,\"publicationDate\":\"2025-01-20\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14984\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Digestive Endoscopy\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1111/den.14984\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Digestive Endoscopy","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/den.14984","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
Closure method to prevent leakages from perforations using multiple over-the-scope clips in an over-the-line method
An over-the-scope clip (OTSC; Ovesco Endoscopy GmbH, Tuebingen, Germany) is a very useful device for the closure of perforations.1 However, when multiple OTSCs are used in sequence for large perforations, the outer projections of the OTSCs create gaps. A reopenable clip-over-the-line method uses multiple clips. However, by pulling a thread, the gaps between clips are reduced.2, 3 We have attempted to close perforations using multiple OTSCs in an over-the-line method (MOLM) (Figs 1, 2).
Two OTSCs were used for the closure of an artificial perforation in a resected porcine stomach. First, nylon thread was passed through the gap, between the first OTSC and hood, and ligated to the OTSC. Second, the first OTSC was attached to an endoscope with the thread facing inward and closure was undertaken from the edge of the perforation. Third, after the second OTSC was attached to the endoscope, the thread tied to the first OTSC was withdrawn from the endoscope tip into the working channel. The endoscope was inserted into the stomach. Finally, the thread was pulled until the two OTSCs came together and the remaining perforation was closed. Excess thread was cut by a Loop Cutter (Olympus, Tokyo, Japan) and the procedure was terminated. Observation by endoscopy from inside the lumen showed complete closure. Further pressure was then applied using water in the stomach but no leakage was observed. Even a 3 cm diameter defect could be closed in the same way from the edge with four OTSCs and a Twin Grasper (Ovesco Endoscopy GmbH) (Video S1).
By using a MOLM, it is possible to eliminate gaps between OTSCs and to provide strong and leak-free closures of large perforations.
Authors declare no conflict of interest for this article.
期刊介绍：
Digestive Endoscopy (DEN) is the official journal of the Japan Gastroenterological Endoscopy Society, the Asian Pacific Society for Digestive Endoscopy and the World Endoscopy Organization. Digestive Endoscopy serves as a medium for presenting original articles that offer significant contributions to knowledge in the broad field of endoscopy. The Journal also includes Reviews, Original Articles, How I Do It, Case Reports (only of exceptional interest and novelty are accepted), Letters, Techniques and Images, abstracts and news items that may be of interest to endoscopists.
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