Background and Aims

Over-the-scope clips (OTSCs) are now becoming popular in endoscopy performed in adults for indications such as acute nonvariceal GI bleeding, anastomotic bleeding, and for closure of gastrocutaneous and postgastrostomy fistulae. Varied sizes of clip are available, but even the smallest, 8.5 to 9.8 mm in diameter with its loading device on the tip of the endoscope, increases device and endoscope intubation diameters up to 14.65 mm. This may present challenges in terms of the size of the patient in whom it might be used. OTSCs appear to be effective and safe in the hands of those who are trained appropriately in endoscopy on adult patients; however, the experience of OTSC application in children is not reported. Here we present results of a service evaluation of this technology at 2 regional/national referral pediatric endoscopy units in the United Kingdom and the United States.

Methods

Two tertiary centers’ databases were searched to identify cases in which OTSCs were used. Demographics, presentation, anthropometry, comorbidities, efficacy, adverse events, and postprocedure follow-up were recorded, with identification of resolution or recurrence.

Results

OTSC procedures were performed on 24 occasions in 20 patients (11 girls) between February 2018 and February 2021. Patients had a mean age of 12 years (range, 5-17) and a mean weight of 44.42 kg (range, 18.2-70.3). Indications were nonhealing PEG site fistulae (n = 7), acute nonvariceal upper GI bleeding (ANUGIB) from gastric ulcers (5), ANUGIB from duodenal ulcers (3), nonhealing bleeding anastomotic ulcer (3), esophageal mucocutaneous fistula (1), and gastric perforation (1). Technical success was achieved in all but 1 case (95%), and clinical success was achieved in 18 cases (90%).

Conclusions

The OTSC device appears to be effective in children (minimum age 5 years and minimum weight 18 kg) in a limited number of situations including anastomotic ulcer, closure of leaking PEG site, gastric perforation, and bleeding peptic ulcers. The operator should be an experienced endotherapeutic endoscopist with specific OTSC training, and the type and size of the OTSC device should be carefully considered, along with any comorbidities of the patient that may preclude success and/or lead to potential adverse events such as esophageal perforation.

中文翻译：

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超范围夹在儿童中的适用性、有效性和安全性

背景和目标

超范围夹 (OTSC) 现在在成人内窥镜检查中越来越流行，用于适应症，例如急性非静脉曲张 GI 出血、吻合口出血，以及用于闭合胃皮肤和胃造口术后瘘管。有各种尺寸的夹子可供选择，但即使是最小的直径为 8.5 至 9.8 毫米的夹子，其装载装置位于内窥镜尖端，可将装置和内窥镜插管直径增加到 14.65 毫米。这可能会在可能使用它的患者的大小方面提出挑战。OTSC 在那些接受过适当内窥镜检查培训的成人患者手中似乎是有效和安全的；但是，没有报道OTSC在儿童中的应用经验。

方法

搜索了两个三级中心的数据库，以确定使用 OTSC 的案例。记录人口统计学、表现、人体测量学、合并症、疗效、不良事件和术后随访，并确定解决或复发。

结果

2018 年 2 月至 2021 年 2 月期间，20 名患者（11 名女孩）进行了 24 次 OTSC 手术。患者的平均年龄为 12 岁（范围，5-17 岁），平均体重为 44.42 公斤（范围，18.2-70.3） . 适应症是不愈合的 PEG 部位瘘 (n = 7)、胃溃疡引起的急性非静脉曲张性上消化道出血 (ANUGIB) (5)、十二指肠溃疡引起的 ANUGIB (3)、吻合口溃疡不愈合出血 (3)、食管黏膜皮肤瘘 (1)、和胃穿孔（1）。除 1 例 (95%) 外均取得技术成功，18 例 (90%) 取得临床成功。

结论

OTSC 装置似乎对儿童（最小年龄 5 岁，最小体重 18 公斤）在少数情况下有效，包括吻合口溃疡、PEG 渗漏部位闭合、胃穿孔和消化性溃疡出血。操作者应该是经验丰富的内镜治疗内镜医师，接受过专门的 OTSC 培训，并且应仔细考虑 OTSC 装置的类型和尺寸，以及可能妨碍成功和/或导致食管穿孔等潜在不良事件的患者合并症.