@ScopingSundays @JamesHaddadMD @TomTielleman @tareksawas @BilalMohammadMD @AhmadBazarbashi @RobertoSimonsMD @SanchezLunaMD @vaibhav_manu @rmulkimd @NnekaUfereMD @LizzieAbyMD @DrMalSimons @JacquelineChuMD TTSC
ππ» Effective for perfs <1 cm
*οΈβ£ Apply in a serial parallel fashion
*οΈβ£ Use enhancing maneuvers like suctioning to invert and approximate the edges for better grip
π« Can use multiple
π Technically easy
#ScopingSundays
ππ» Effective for perfs <1 cm
*οΈβ£ Apply in a serial parallel fashion
*οΈβ£ Use enhancing maneuvers like suctioning to invert and approximate the edges for better grip
π« Can use multiple
π Technically easy
#ScopingSundays
@ScopingSundays @JamesHaddadMD @TomTielleman @tareksawas @BilalMohammadMD @AhmadBazarbashi @RobertoSimonsMD @SanchezLunaMD @vaibhav_manu @rmulkimd @NnekaUfereMD @LizzieAbyMD @DrMalSimons @JacquelineChuMD Many clips available (image)
π R360, SureC & DuraC = β¬οΈ rotatability
π SureC & R360 = β¬οΈ overshoot
π€ SureC & DuraC = precise opening/closing
πͺπ» Quick Clip Pro = β¬οΈ peak force
π¦Ύ Instinct & R360 = β¬οΈ closure strength and 100% deployment success
(Wang et al, 2019)
π R360, SureC & DuraC = β¬οΈ rotatability
π SureC & R360 = β¬οΈ overshoot
π€ SureC & DuraC = precise opening/closing
πͺπ» Quick Clip Pro = β¬οΈ peak force
π¦Ύ Instinct & R360 = β¬οΈ closure strength and 100% deployment success
(Wang et al, 2019)
@ScopingSundays @JamesHaddadMD @TomTielleman @tareksawas @BilalMohammadMD @AhmadBazarbashi @RobertoSimonsMD @SanchezLunaMD @vaibhav_manu @rmulkimd @NnekaUfereMD @LizzieAbyMD @DrMalSimons @JacquelineChuMD For larger defects, combined Endoloop and TTSC closure can be considered π€
π₯ Endoloop + TTSC = π₯ OTSC in terms of safety and efficacy (Dolozel et al, 2016)
#ScopingSundays
π₯ Endoloop + TTSC = π₯ OTSC in terms of safety and efficacy (Dolozel et al, 2016)
#ScopingSundays
@ScopingSundays @JamesHaddadMD @TomTielleman @tareksawas @BilalMohammadMD @AhmadBazarbashi @RobertoSimonsMD @SanchezLunaMD @vaibhav_manu @rmulkimd @NnekaUfereMD @LizzieAbyMD @DrMalSimons @JacquelineChuMD OTSC
Systems
π OVESCO (more widely used) π Padlock clip
Sizes
β 4 cap & clip sizes (mini, 11, 12, 14)
β 2 cap depths (3 & 6 mm)
3 set of π¦·
(t) traumatic = used to close fistulas and perforations βοΈ
(a) atraumatic = used for hemostasis π©Έ
(gc) gastrostomy closure
Systems
π OVESCO (more widely used) π Padlock clip
Sizes
β 4 cap & clip sizes (mini, 11, 12, 14)
β 2 cap depths (3 & 6 mm)
3 set of π¦·
(t) traumatic = used to close fistulas and perforations βοΈ
(a) atraumatic = used for hemostasis π©Έ
(gc) gastrostomy closure
@ScopingSundays @JamesHaddadMD @TomTielleman @tareksawas @BilalMohammadMD @AhmadBazarbashi @RobertoSimonsMD @SanchezLunaMD @vaibhav_manu @rmulkimd @NnekaUfereMD @LizzieAbyMD @DrMalSimons @JacquelineChuMD A systematic review (Bartell et al, 2020) showed:
π Successful deployment of OTSCs in 94.4% cases
βπ»Overall success rate of 78.4%
ππΌ Low adverse event rate (2%)
βοΈ Salvage surgery reqd in only 4.7% cases!
#ScopingSundays
π Successful deployment of OTSCs in 94.4% cases
βπ»Overall success rate of 78.4%
ππΌ Low adverse event rate (2%)
βοΈ Salvage surgery reqd in only 4.7% cases!
#ScopingSundays
@ScopingSundays @JamesHaddadMD @TomTielleman @tareksawas @BilalMohammadMD @AhmadBazarbashi @RobertoSimonsMD @SanchezLunaMD @vaibhav_manu @rmulkimd @NnekaUfereMD @LizzieAbyMD @DrMalSimons @JacquelineChuMD Technique
π― Target the lesion
π₯€Aspirate tissue into cap
ππΌ Approximate tissue β use twin grasper or a retractable tissue anchor
𧨠Deploy
π€ Consider prior endoscopy with a transparent distal attachment: if cannot grasp edges of defect to cap, low chance of OTSC success
π― Target the lesion
π₯€Aspirate tissue into cap
ππΌ Approximate tissue β use twin grasper or a retractable tissue anchor
𧨠Deploy
π€ Consider prior endoscopy with a transparent distal attachment: if cannot grasp edges of defect to cap, low chance of OTSC success
@ScopingSundays @JamesHaddadMD @TomTielleman @tareksawas @BilalMohammadMD @AhmadBazarbashi @RobertoSimonsMD @SanchezLunaMD @vaibhav_manu @rmulkimd @NnekaUfereMD @LizzieAbyMD @DrMalSimons @JacquelineChuMD In summary π
π’ defects <1 cm = TTSC
π’ defects 2-3 cm = OTSC or TTSC plus endoloop βΎοΈ
β° OTSC may be difficult in R colon or tortuous colons βοΈ
#ScopingSundays
π’ defects <1 cm = TTSC
π’ defects 2-3 cm = OTSC or TTSC plus endoloop βΎοΈ
β° OTSC may be difficult in R colon or tortuous colons βοΈ
#ScopingSundays
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