The Over-The-Scope-Clip Device: An Indispensable Tool in Interventional Endoscopy: A Case Series

Abstract

The Over-The-Scope Clip (OTSC) is a novel endoscopic clipping device designed for tissue approximation. It offers an effective endoscopic approach for fistula closure, luminal perforation, GI bleeding, and resection of intra-diverticular colon polyps. We report successful use of this device in a variety of challenging endoscopic scenarios (Figure 1).Figure 1Cases: 1) 53M with history of (h/o) prior feeding tube, presented with (p/w) a non-healing gastro-cutaneous fistula that was successfully closed using one OTSC. 2) 64M with h/o of PUD s/p Billroth II and chronic pancreatitis underwent ERCP with stent placement for CBD stricture. He presented 6 weeks later with perforation of the lateral duodenal wall by the stent. The stent was removed and the perforation was successfully closed using one OTSC device. 3) 67M with h/o cirrhosis p/w a massive GI bleed. Evaluation with EGD and angiogram x2 failed to reveal a source. Push enteroscopy showed an actively bleeding duodenal varix. Ethanolamine injection and band ligation were ineffective. Deployment of the OTSC over the varix resulted in complete and immediate hemostasis. 4) 49M p/w hematemesis. EGD revealed a 2cm duodenal bulb ulcer with a large (>2mm) vessel. Attempts to treat the vessel using standard hemostasis techniques were unsuccessful. One OTSC was deployed over the bleeding vessel with successful hemostasis. 5) 63F with colo-vaginal fistula secondary to Crohn's disease was referred for endoscopic closure. One OTSC device successfully closed the fistula. Discussion/Conclusions: The OTSC device is an excellent tool for treating GI tract hemorrhage, small perforations, and post-op fistulae. While evidence in management of various conditions mentioned above is accumulating, large-scale head-to-head studies are lacking. Further studies are necessary, but the OTSC device represents a valuable tool for high-risk patients that are poor surgical candidates. We describe a case series of patients in which the OTSC device was used for a variety of challenging indications in endoscopic practice.