Use of OTSC Device System for Closure of Fistulas in the Alimentary Tract – A Case Series

Abstract

ObjectiveWe report our experience – a case series with the Over the Scope Clip (OTSC), Bear claw, a novel and new tool for the endoscopic entrapment of tissue for closure of fistula and perforations. DesignSingle-center. SettingTertiary referral academic gastroenterology unit and center for advanced therapeutic endoscopy. PatientCase I – referred for endoscopic treatment for the closure of gastrocutaneous fistula (GC).Case II – referred for endoscopic treatment for the closure of colo-vaginal fistula.Case III – referred for endoscopic treatment for the closure of GC fistula. InterventionThe OTSC system was mounted on the tip of the scope and passed down to the level of the fistula. The targeted site of the fistula was grasped with the tissue anchoring tripod and pulled into the cap with concomitant scope channel suction. Once the tissue was trapped in the cap, the Bear claw was deployed. Main outcome measurementsNA. ResultsAll patients recovered. No complication or recurrence noted. Case I showed successful results with closure of the fistula. Case II fistula was not closed due to the cavity beneath the fistula probably abscess formation – which prevented the healing of the fistula site despite of the closure with OTSC. Case III fistula did not close successfully due to the larger diameter of the fistula which was greater than 1 cm. ConclusionWith several new devices being introduced, it is difficult to judge the implementation of one tool over the others. This device has shown promising results for fistula closure if used knowing the limitation of the product.