Over-the-scope-grasper: A new tool for pancreatic necrosectomy and beyond - first multicenter experience

Markus Brand; Jeannine Bachmann; Christoph Schlag; Ulrich Huegle; Imdadur Rahman; Edris Wedi; Benjamin Walter; Oliver Möschler; Lukas Sturm; Alexander Meining

doi:10.4240/wjgs.v14.i8.799

Over-the-scope-grasper: A new tool for pancreatic necrosectomy and beyond - first multicenter experience

World J Gastrointest Surg. 2022 Aug 27;14(8):799-808. doi: 10.4240/wjgs.v14.i8.799.

Authors

Affiliations

¹ Department of Internal Medicine II, University of Würzburg, Würzburg 97080, Germany. brand_m@ukw.de.
² Department of Surgery, Klinikum rechts der Isar, University of München, München 81675, Germany.
³ Department of Gastroenterology and Hepatology, University of Zürich, Zürich 8091, Switzerland.
⁴ Department of Gastroenterology and Hepatology, Klinikum Köln-Holweide, Köln 50968, Germany.
⁵ Department of Gastroenterology, University Hospital Southampton, Southampton SO16 6YD, United Kingdom.
⁶ Department of Gastroenterology, Gastrointestinal Oncology and Interventionell Endoscopy, Sana Klinikum Offenbach, Offenbach 63069, Germany.
⁷ Department of Internal Medicine I, University of Ulm, Ulm 89070, Germany.
⁸ Department of Gastroenterology, Marienhospital Osnabrück, Osnabrück 49074, Germany.
⁹ Department of Internal Medicine II, University of Freiburg, Freiburg 79106, Germany.
¹⁰ Department of Internal Medicine II, University of Würzburg, Würzburg 97080, Germany.

Abstract

Background: Endoscopic treatment of pancreatic necrosis can be challenging and time-consuming because sticky necrotic debris is sometimes difficult to remove. The over-the-scope-grasper, a new tool that has recently become available for this purpose, might also be useful for other indications. However, clinical data on the efficacy and safety of this new device are lacking.

Aim: To evaluate the technical success and safety of the device in a multicenter setting.

Methods: The over-the-scope-grasper was used in nine selected endoscopic centers between November 2020 and October 2021 for appropriate indications. Overall, 56 procedures were included in the study. We retrospectively evaluated procedural parameters of all endoscopic interventions using a predefined questionnaire, with special respect to technical success, indications, duration of intervention, type of sedation, and complications. In the case of pancreatic necrosectomy, the access route, stent type, number of necrosis pieces removed, and clinical handling were also recorded.

Results: A total of 56 procedures were performed, with an overall technical success rate of 98%. Most of the procedures were endoscopic pancreatic necrosectomies (33 transgastric, 4 transduodenal). In 70% of the procedures, access to the necrotic cavity was established with a lumen apposing metal stent. The technical success of pancreatic necrosectomy was 97%, with a mean of 8 pieces (range, 2-25 pieces) of necrosis removed in a mean procedure time of 59 min (range, 15-120 min). In addition, the device has been used to remove blood clots (n = 6), to clear insufficiency cavities before endoluminal vacuum therapy (n = 5), and to remove foreign bodies from the upper gastrointestinal tract (n = 8). In these cases, the technical success rate was 100%. No moderate or severe/fatal complications were reported in any of the 56 procedures.

Conclusion: These first multicenter data demonstrate that the over-the-scope-grasper is a promising device for endoscopic pancreatic necrosectomy, which is also appropriate for removing foreign bodies and blood clots, or cleaning insufficiency cavities prior to endoluminal vacuum therapy.

Keywords: Direct endoscopic necrosectomy; Endoscopic pancreatic necrosectomy; Endoscopic tool; Grasper; Over-the-scope-grasper; Pancreatic necrosis.