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

Colin G. Delong, Alexander T. Liu, Joshua S. Winder, Eric M. Pauli

Research output: Contribution to journalArticlepeer-review

Abstract

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 guide-wire 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.

Original languageEnglish (US)
Article numbere2022.00069
JournalJournal of the Society of Laparoendoscopic Surgeons
Volume27
Issue number1
DOIs
StatePublished - Jan 1 2023

All Science Journal Classification (ASJC) codes

  • Surgery

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