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P157 No strings attached: over-the-scope (OVESCO) clip to a post-appendicectomy stump leak
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P157 No strings attached: over-the-scope (OVESCO) clip to a post-appendicectomy stump leak
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Journal Article
P157 No strings attached: over-the-scope (OVESCO) clip to a post-appendicectomy stump leak
2022
Overview
A 60-year-old man with a history of heart transplant and renal failure on dialysis was referred for an OVESCO clip to a post appendicectomy stump leak. He had a radiologically placed external drain to a collection which was actively draining faecal matter. The leak failed to close with several weeks of conservative management. Endoscopic management was favoured as initial management due to his anaesthetic risk factors.The fistula site was identified at the appendix stump and confirmed on fluoroscopy with wire passage and contrast extravasation. The OTSC Twin Grasper was put down the working channel in an attempt to draw the two edges of the fistula into the cap. Unfortunately, this caught on the OVESCO string and the string was sheared in the working channel.A grasper and biopsy forceps were used in attempt to grab the slack end of the string and release the clip but neither were able to grip sufficiently. The procedure was abandoned and a further reattempt was scheduled.This time the fistula was easily identified and OVESCO clip successfully deployed. Fluoroscopy confirmed no contrast leak and methylene blue was sprayed in the caecum to aid in confirmation of closure. The patient recovered well and drain output stopped with no methylene blue seen. He was discharged soon after.Video link: OVESCO COLONIC_BSG_FINAL (vimeo.com)
Publisher
BMJ Publishing Group Ltd and British Society of Gastroenterology,BMJ Publishing Group LTD
Subject
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