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

Abstract

Introduction: The Over-The-Scope Clip (OTSC) is a novel device designed for tissue approximation. It offers an effective endoscopic approach for fistula closure, luminal perforation, and GI bleeding. We report successful use of this device in a series of patients (Table 1).Table 1: Summary of CasesCases: 1) 53-year-old male with history of (h/o) prior feeding tube, presented with (p/w) a nonhealing gastro-cutaneous fistula that was successfully closed using one OTSC. 2) 64-year-old male with h/o 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) 67-year-old male with h/o cirrhosis p/w a massive GI bleed. Evaluation with EGD and angiogram x2 failed to reveal a source. Push enteroscopy showed a bleeding duodenal varix. Ethanolamine injection and band ligation were ineffective. Deployment of the OTSC resulted in immediate hemostasis. 4) 49-year-old male p/w hematemesis. EGD revealed a 2 cm duodenal bulb ulcer with a >2 mm bleeding vessel. Attempt to cauterize with a heater probe was unsuccessful. Epinephrine was injected and an OTSC was deployed with successful hemostasis. 5) 57-year-old male with h/o a prior PEG tube was referred for a non-healing gastro-cutaneous fistula. Successful fistula closure was achieved with placement of two OTSC devices. 6) 68-year-old male with h/o esophageal cancer s/p remote esophagectomy, p/w a non-healing gastro-pulmonary fistula. Two OTSC devices were placed in contiguity to close the fistula. Post-EGD the tracheal secretions became clear with no further bilious output*. The patient ultimately required surgery. 7) 73-year-old female with h/o cirrhosis underwent endoscopic submucosal dissection of a 4 cm Type 0-IIa gastric adenocarcinoma. A 4 mm focal perforation of the muscle layer was successfully closed using one OTSC. 8) 36-year-old male with a colo-cutaneous fistula was referred for endoscopic closure. The OTSC device successfully closed the fistula. The patient was lost to follow-up. Discussion: The OTSC device is an excellent tool for treating GI tract hemorrhage, small perforations, and post-op fistulae. We describe a case series of patients in which the OTSC device was used for a variety of challenging indications.