OTSC System in All Possible Applications
The development of endoscopic closure devices such as over-the-scope-clips (OTSCs) has made endoscopic management of gastrointestinal fistulas or gastrointestinal bleedings feasible. These nonsurgical approaches have a lower complication rate, shorten the
- PDF / 807,511 Bytes
- 22 Pages / 439.37 x 666.142 pts Page_size
- 90 Downloads / 173 Views
OTSC System in All Possible Applications Rita Conigliaro, Santi Mangiafico, Giuseppe Iabichino, Monica Arena, and Carmelo Luigiano
2.1
Introduction
The OTSC® system (Ovesco Endoscopy AG, Tübingen, Germany) consists of a nitinol alloy, which allows a high grade of elasticity and was designed to overcome the limitations of traditional through-the-scope (TTS) clips allowing a significantly larger mechanical circumferential compression of large tissue areas, surrounding the vessel without direct trauma. When released from the applicator, the shape-memory effect and the high grade of elasticity of the nitinol alloy cause closure of the clip. The shape-memory alloy effects a permanent closing force of the OTSCs between 8 and 9 newtons. Because of the superelastic effect of nitinol, the force is permanently applied. Phantom tests and animal survival studies have shown that this closing force is necessary to reach sufficient compression of tissue. OTSC has shown its encouraging results in management of various clinical situations also critical as the closure of gastrointestinal fistulas, iatrogenic perforations during endoscopy, anastomotic leaks and post bariatric surgery, bleeding lesions, complications and closure of gastrostomies during natural orifice transluminal endoscopic surgery. Therefore in this chapter we present all the possible applications of the OTSC devices including.
R. Conigliaro, MD (*) • S. Mangiafico Digestive Endoscopy Unit, Baggiovara Hospital, Modena, Italy e-mail: [email protected] G. Iabichino • M. Arena • C. Luigiano Digestive Endoscopy Unit, San Paolo Hospital, Milano, Italy © Springer International Publishing Switzerland 2017 R. Conigliaro, M. Frazzoni (eds.), Diagnosis and Endoscopic Management of Digestive Diseases, DOI 10.1007/978-3-319-42358-6_2
21
22
R. Conigliaro et al.
a
c
b
e
d
Fig. 2.1 OTSC system. (a) Atraumatic: short teeth for vessels. OTSC. (b) Traumatic regular type: pointed teeth for fistula’ s wall. OTSC. (c) Traumatic gastric-type clip (gc): longer pointed teeth for gastric wall. OTSC. (d) Atraumatic clip installed on the tip of an endoscope. OTSC (e) the tip of the endoscope loaded with clip and a “twin Gasper” sometimes used to get the tissue
2.2
Technical Concepts
The over-the-scope clip system must be mounted onto the tip of the scope by the applicator with a loading coil, which assists in the opening of the clip. The applicator consists of a cylindrical cap, a wire, and a protection cap. When the clip is opened, it fits to the shape of the cylindrical cap. The cap is mounted onto the tip of the endoscope. Two different configurations are available: the “atraumatic” version with blunt teeth and the “traumatic” version with two types of sharp teeth (“regular” and “gastric” types) (Fig. 2.1). The application for bleeding is shown in Fig. 2.2. The application for the treatment of fistulas is similar, but two types of forceps as shown in Fig. 2.3 can also be used.
2.3
OTSC in GI Bleeding
Gastrointestinal bleeding is a frequent event in clinic
Data Loading...
