Over-the-scope Clip Research Articles

1050 Misplaced “Bear Claw” in a Bleeding Gastric Ulcer: What Next?

The over the scope clip (OTSC) with its large claw captures a large amount of tissue and clamp deeply below the vessel. In acute bleeding, proper deployment technique and accurate clip placement is crucial. However, when misplaced, removal of OTSC can be extremely difficult. In this case, we describe the endoscopic technique to manage a misplaced OTSC and treat a large bleeding gastric ulcer.

Early endoscopic closure of colocutaneous fistula adjacent to unmatured low colorectal anastomosis with the Over-The-Scope Clip (OTSC)

We herein describe the case of an 82-year-old man with colocutaneous fistula adjacent to an unmatured but intact low colorectal anastomosis after low anterior resection for rectal adenocarcinoma. Early in the course, an OTSC (Over-The-Scope Clip) was successfully placed onto the fistula’s internal orifice, with concomitant reduction in our patient’s morbidity.

Mo2002 Over the Scope Clips (OTSC) Are Highly Successful in Managing High-Risk Gastrointestinal Bleeding Lesions

Mo2002 Over the Scope Clips (OTSC) Are Highly Successful in Managing High-Risk Gastrointestinal Bleeding Lesions

Mo2059 Efficacy and Safety of Over-the-Scope Clip (OTSC) in the Endoscopic Closure of Fistula and Perforation in the Gastrointestinal Tract: A Case Series

Mo2059 Efficacy and Safety of Over-the-Scope Clip (OTSC) in the Endoscopic Closure of Fistula and Perforation in the Gastrointestinal Tract: A Case Series

Mo2049 Over-the-Scope Clip System Versus Endoloop Combined With Metal Clips Applied to Closure of Perforation in Gastric Endoscopic Full-Thickness Resection: A Single-Center Prospective Comparison Study

To compare safety and efficacy of a novel closure device, over-the-scope clip (OTSC) system, with endoloop and metal clips, applied to gastric endoscopic full-thickness (EFTR) for submucosal tumors (SMTs).

Over-the-scope clip

AbstractThe endoscopic clips were first described by Hayashi in Japan in 1975. Since then, many different types of clips have been introduced to the gastroenterology practice. Over-the-scope clip (OTSC) or the “beer claw” was introduced in the year 2010. It works on the principle of dynamic compression and is applied over the scope like a band ligator. OTSC is a new endoscopic modality which can be used in acute gastrointestinal hemorrhage, iatrogenic perforation, anastomotic leak, and chronic fistula treatment with fairly good success rate and therefore, is now being considered as an alternative to surgery, especially in situations where surgery is not feasible.

Sa2019 Outcomes of Over-the-Scope Clip (OTSC) Use in Gastrointestinal Tract: A Large Tertiary Care Center Experience

Sa2019 Outcomes of Over-the-Scope Clip (OTSC) Use in Gastrointestinal Tract: A Large Tertiary Care Center Experience

Salvage of a failed open gastrocutaneous fistula repair with an endoscopic over-the-scope clip

Abstract Once enteral access via gastrostomy tube (G-tube) is no longer indicated, the tube is typically removed in clinic with a high probability of spontaneous closure. When spontaneous closure is not achieved, the formation of a gastrocutaneous fistula (GCF) is possible. The incidence of GCF is directly related with the length of time the tube has been placed. When conservative management fails, surgical intervention is the standard treatment. Endoscopic techniques have been described for primary closure of GCF in adults including banding and cauterizing of the fistula tract with placement of a standard endoscopic clip. Over-the-scope clips (OTSC) have recently been reported in primary GCF closure in children (Wright et al., 2015). In patients with skin irritation surrounding a GCF making surgical repair difficult, endoscopic OTSC closure provides particular benefit. It is our belief that this is the first case report of endoscopically salvaging a leak from a failed open GCF repair.

Advances on endoscopic treatment of intestinal fistulas

Intestinal fistulas are severe complications after abdominal surgical procedures. The endoscopic therapy makes it possible to close fistulas without surgical interventions. When patients achieved stabilization and had no signs of systemic sepsis or inflammation, these therapies could be conducted, which included endoscopic vacuum therapy, fibrin glue sealing, stents, fistula plug, suture, and Over The Scope Clip (OTSC). Various techniques may be combined. Endoscopy vacuum therapy could be applied to control systemic inflammation and prevent continuing septic contamination by active drainage. Endoscopic stent is placed over fistulas and gastrointestinal continuity is recovered. The glue sealing is applied for enterocutaneous fistulas, and endoscopy suture has the best results seen in fistulas <1 cm in diameter. Insertion of the fistula plug is used to facilitate fistula healing. The OTSC is effective to treat leaks with large defects. Endoscopic treatment could avoid reoperation and could be regarded as the first-line treatment for specific patients.

P-004 Successful Closure of Crohnʼs Associated Anovaginal Fistula Involving the Dentate Line Using Over-The-Scope-Clip (OTSC)

P-004 Successful Closure of Crohnʼs Associated Anovaginal Fistula Involving the Dentate Line Using Over-The-Scope-Clip (OTSC)

New methods for endoscopic hemostasis: focus on non-variceal gastrointestinal bleeding

Gastrointestinal bleeding is a frequent emergency in daily clinical practice of a gastroenterologist. While incidence and mortality of gastrointestinal bleeding are decreasing in many countries, numbers of endoscopic procedures are increasing. Endoscopic therapy of non-variceal gastrointestinal bleeding is still mainly based on "classical" procedures like injection of vasoactive drugs (i. e. epinephrine) or blood derivates, application of through-the-scope hemoclips (TTSC), Argon plasma coagulation and bipolar coagulation. However, in the last years new endoscopic techniques especially for non-variceal gastrointestinal bleedings have become available and enriched our endoscopic equipment. For example, over-the-scopeclips (OTSCs) surpass the size of TTSCs and havebeen successfully established for treatment of gastrointestinal bleeding and leak closure of fistulas and perforations. In addition, hemostatic powders were shown to achieve primary hemostasis in several cases of gastrointestinal bleeding. Besides a brief overview of "classical" endoscopic procedures for hemostasis of non-variceal gastrointestinal bleeding, this review focuses on new epidemiological data and uprising methods for endoscopic hemostasis.

Use of the over-the-scope clip to treat massive bleeding at the transitional zone of the anal canal: a case series

Endoscopic treatment of anorectal bleeding can be challenging. We report use of the endoscopic over-the-scope clip (OTSC) to treat massive bleeding from the transitional zone of the anorectum. The aim of this retrospective study was to assess the clinical outcome and efficacy of the OTSC and to describe the technique of its use in acute severe bleeding occurring at the transitional zone of the anorectum. We treated 5 consecutive patients (age range, 36-79 years, 5 men) with severe bleeding from the transitional zone of the anorectum caused by hemorrhoid therapy, digital trauma, and a Dieulafoy lesion. We analyzed the efficacy, safety, and outcome of endoscopic treatment using the OTSC. Primary hemostasis was successfully achieved in all the patients using a single OTSC. The OTSC deployment technique was adapted from the endoscopic band ligation of hemorrhoids. There was no immediate or late rebleeding. We observed that there were no adverse events from OTSC placement in the anorectum. This case series provides evidence that OTSCs may be effective in controlling bleeding from the transitional zone of the anorectum. Although use of OTSCs for bleeding elsewhere in the GI tract has been described, this case series is the first to show its application in the transitional zone of the anorectum.

Endoscopic closure of colonic perforations using over-the-scope clip: a surgeon-sparing technique.

The incidence of perforation during diagnostic colonoscopy has been reported to be 0.2%, however this increases to 5% during therapeutic colonoscopy [1]. The current approach to manage these complications encountered during colonoscopy is surgical repair. With the advances in the field of therapeutic endoscopy, the role of over-the-scope clip (OTSC) in managing this dreaded complication seems to be very promising [2]. Although experience in porcine models proved the OTSC’s usefulness in the successful closure of full thickness perforations, we still lack experience with humans to label it as a standard approach [3]. Here we would like to share interesting images from our experience with OTSC in dealing with colonic perforations during colonoscopy. An 87-year-old female with multiple co-morbidities underwent colonoscopy for evaluation of severe iron defi ciency anemia and multiple polyps in the past. At the recto-sigmoid junction we found multiple medium sized diverticula, of which one appeared to be diff erent with yellowish tissue suggestive of omentum (Fig. 1A,B). Colonic perforation was suspected and we decided to manage that endoscopically using OTSC 12/6 GC. Th e endoscopic closure of the defect was performed successfully using the standard OTSC technique (Fig. 1C). Computed tomography of the abdomen with oral contrast revealed no contrast extravasation and the clip completely approximated the defect. Th e patient was discharged from the hospital aft er an uneventful observation in the surgical unit for 48 h. Th ere is limited information available in the current literature regarding the benefi ts of OTSC in the management of colonic perforation in humans. We believe that the OTSC will be a helpful tool in dealing with iatrogenic colonic perforation, if identifi ed early with a signifi cant level of confi dence. In contrast to a surgical approach, usage of the OTSC can potentially avoid surgical and anesthesia complications, shorten the length of hospitalization and be ideal for frail highrisk patients.

First-line endoscopic treatment with over-the-scope clips significantly improves the primary failure and rebleeding rates in high-risk gastrointestinal bleeding: A single-center experience with 100 cases.

AIMTo evaluate rebleeding, primary failure (PF) and mortality of patients in whom over-the-scope clips (OTSCs) were used as first-line and second-line endoscopic treatment (FLET, SLET) of upper and lower gastrointestinal bleeding (UGIB, LGIB).METHODSA retrospective analysis of a prospectively collected database identified all patients with UGIB and LGIB in a tertiary endoscopic referral center of the University of Freiburg, Germany, from 04-2012 to 05-2016 (n = 93) who underwent FLET and SLET with OTSCs. The complete Rockall risk scores were calculated from patients with UGIB. The scores were categorized as < or ≥ 7 and were compared with the original Rockall data. Differences between FLET and SLET were calculated. Univariate and multivariate analysis were performed to evaluate the factors that influenced rebleeding after OTSC placement.RESULTSPrimary hemostasis and clinical success of bleeding lesions (without rebleeding) was achieved in 88/100 (88%) and 78/100 (78%), respectively. PF was significantly lower when OTSCs were applied as FLET compared to SLET (4.9% vs 23%, P = 0.008). In multivariate analysis, patients who had OTSC placement as SLET had a significantly higher rebleeding risk compared to those who had FLET (OR 5.3; P = 0.008). Patients with Rockall risk scores ≥ 7 had a significantly higher in-hospital mortality compared to those with scores < 7 (35% vs 10%, P = 0.034). No significant differences were observed in patients with scores < or ≥ 7 in rebleeding and rebleeding-associated mortality.CONCLUSIONOur data show for the first time that FLET with OTSC might be the best predictor to successfully prevent rebleeding of gastrointestinal bleeding compared to SLET. The type of treatment determines the success of primary hemostasis or primary failure.

One hundred and one over-the-scope-clip applications for severe gastrointestinal bleeding, leaks and fistulas.

To investigate the efficacy and clinical outcome of patients treated with an over-the-scope-clip (OTSC) system for severe gastrointestinal hemorrhage, perforations and fistulas. From 02-2009 to 10-2012, 84 patients were treated with 101 OTSC clips. 41 patients (48.8%) presented with severe upper-gastrointestinal (GI) bleeding, 3 (3.6%) patients with lower-GI bleeding, 7 patients (8.3%) underwent perforation closure, 18 patients (21.4%) had prevention of secondary perforation, 12 patients (14.3%) had control of secondary bleeding after endoscopic mucosal resection or endoscopic submucosal dissection (ESD) and 3 patients (3.6%) had an intervention on a chronic fistula. In 78/84 patients (92.8%), primary treatment with the OTSC was technically successful. Clinical primary success was achieved in 75/84 patients (89.28%). The overall mortality in the study patients was 11/84 (13.1%) and was seen in patients with life-threatening upper GI hemorrhage. There was no mortality in any other treatment group. In detail OTSC application lead to a clinical success in 35/41 (85.36%) patients with upper GI bleeding and in 3/3 patients with lower GI bleeding. Technical success of perforation closure was 100% while clinical success was seen in 4/7 cases (57.14%) due to attendant circumstances unrelated to the OTSC. Technical and clinic success was achieved in 18/18 (100%) patients for the prevention of bleeding or perforation after endoscopic mucosal resection and ESD and in 3/3 cases of fistula closure. Two application-related complications were seen (2%). This largest single center experience published so far confirms the value of the OTSC for GI emergencies and complications. Further clinical experience will help to identify optimal indications for its targeted and prophylactic use.

Over-the-scope clips in the treatment of gastrointestinal tract iatrogenic perforation: A multicenter retrospective study and a classification of gastrointestinal tract perforations

To determine the outcome of the management of iatrogenic gastrointestinal tract perforations treated by over-the-scope clip (OTSC) placement. We retrospectively enrolled 20 patients (13 female and 7 male; mean age: 70.6 ± 9.8 years) in eight high-volume tertiary referral centers with upper or lower iatrogenic gastrointestinal tract perforation treated by OTSC placement. Gastrointestinal tract perforation could be with oval-shape or with round-shape. Oval-shape perforations were closed by OTSC only by suction and the round-shape by the "twin-grasper" plus suction. Main perforation diameter was 10.1 ± 4.3 mm (range 3-18 mm). The technical success rate was 100% (20/20 patients) and the clinical success rate was 90% (18/20 patients). Two patients (10%) who did not have complete sealing of the defect underwent surgery. Based upon our observations we propose two types of perforation: Round-shape "type-1 perforation" and oval-shape "type-2 perforation". Eight (40%) out of the 20 patients had a type-1 perforation and 12 patients a type-2 (60%). OTSC placement should be attempted after perforation occurring during diagnostic or therapeutic endoscopy. A failed closure attempt does not impair subsequent surgical treatment.

Role of endoscopic clipping in the treatment of oesophageal perforations.

With advances in endoscopic technologies, endoscopic clips have been used widely and successfully in the treatment of various types of oesophageal perforations, anastomosis leakages and fistulas. Our aim was to summarize the experience with two types of clips: The through-the-scope (TTS) clip and the over-the-scope clip (OTSC). We summarized the results of oesophageal perforation closure with endoscopic clips. We processed the data from 38 articles and 127 patients using PubMed search. Based on evidence thus far, it can be stated that both clips can be used in the treatment of early (< 24 h), iatrogenic, spontaneous oesophageal perforations in the case of limited injury or contamination. TTS clips are efficacious in the treatment of 10 mm lesions, while bigger (< 20 mm) lesions can be treated successfully with OTSC clips, whose effectiveness is similar to that of surgical treatment. However, the clinical success rate is significantly lower in the case of fistulas and in the treatment of anastomosis insufficiency. Tough prospective randomized multicentre trials, which produce the largest amount of evidence, are still missing. Based on experience so far, endoscopic clips represent a possible therapeutic alternative to surgery in the treatment of oesophageal perforations under well-defined conditions.

Esophageal perforation after epicardial ablation: an endoscopic approach

Endocardial ablation has long been used to treat cardiac arrhythmias. However, the indications for epicardial intervention via the pericardial space have continuously increased since the technique was first described [1–3]. A subxiphoid puncture is used to access the pericardial space (● Fig.1a,● Fig.1b), allowing epicardial mapping and ablation (● Fig.2a, ● Fig.2b). Various complications have been described [4–8], which range from those caused by thepuncture access (damage to the liver, colon, diaphragm, right ventricle, lungs) to those secondary to the ablation itself (damage to the coronary vessels, phrenic nerve, cardiac wall). We present the case of a 63-year-old man admitted who had syncope, caused by transitory ventricular tachycardia secondary to Chagas disease with advanced chronic heart failure. The patient underwent epicardial ablation, which was complicated by the formation of an esophageal–mediastinal fistula, diagnosed with computed tomography and upper gastrointestinal endoscopy 15 days after the procedure. Following amultidisciplinary consultation during which the patient’s overall clinical status was considered, a conservative treatment combining thoracic drainage and the endoscopic placement of an overthe-scope clip was attempted (● Video 1). The procedure was conducted without technical difficulty, and the patient left the intensive care unit on the next day. After 10 days, esophagography showed the clip still in place, with no detectable leakage of contrast medium. Liquid oral intake was initiated, and with progressive improvement in the patient’s clinical status, he was discharged home 3 days later. The patient returned on the 35th day after the endoscopic procedure for a follow-up examination. Endoscopy demonstrated that the metallic clip was no longer in place, but only a small pseudodiverticulum was visible, with no leakage of contrast medium detected on fluoroscopy.

Over-the-Scope Clip Closure of Oesophageal Perforation after Pneumatic Dilatation for Achalasia

Pneumatic dilatation of the oesophagus is the first line method of therapy of achalasia. Pneumatic balloon dilatation induces forceful stretching of the lower oesophageal sphincter (LES), which weakens the LES by tearing its muscle fibers. Complications of Pneumatic balloon dilatation include oesophageal perforation in 1.6 % and heartburn in 45 %. Recently endoscopic approach has been introduced in treating gastrointestinal perforations which is less invasive than surgery and have the advantages of lesser morbidity and mortality, shorter hospital stay, and shorter periods of avoiding oral feeding. The main endoscopic methods used to close GI perforations are endoclips and covered self-expandable stents the margins. We report the case of a 51 year-old female patient presenting with oesophageal tear after pneumatic dilatation for achalasia. Over-the-scope clip (OTSC) was used for the Closure of the oesophageal tear. To the best of our knowledge this is the first case report of successful closure of oesophageal tear secondary to post pneumatic dilation of the oesophagus for the treatment of Achalasia using the OTSC.

Endoscopic closure with an over-the-scope clip of a duodenocolonic fistula caused by a migrated biliary stent

A 71-year-old man with diabetes, dementia, and gout presented with orange urine, nausea, and vomiting. The examination disclosed scleral icterus and jaundice. His laboratory determinations were suggestive of cholangitis: white blood count 21,500/μL, total bilirubin 21.5 mg/dL. CT of the abdomen showed the common bile duct (CBD) to be dilated up to 1.6 cm and migration of the biliary stent with the proximal end in the distal CBD, traversing through the duodenum and the distal end lying within the cecum (A). The duration of, or indication for, previous biliary stenting was not available. Endoscopy showed a straight plastic stent protruding from a bulging ampulla and penetrating the duodenal wall (B). The stent was removed with an alligator forceps, followed by ERCP with drainage of biliary sludge and pus and placement of a biliary stent. Contrast medium was injected with a sphincterotome through the duodenal opening of the fistula, which showed the fistula tract and filling of the cecum and subsequently the ascending colon without any peritoneal extravasation of contrast medium (C). The over-the scope clip (OTSC) anchor was used to retract the duodenal fistula opening, and a 12/6 gastrocutaneous OTSC was deployed for closure (D). An upper GI series was obtained the next day and showed that the OTSC was in a good position without any leak of contrast medium. The patient’s diet was advanced, and he was discharged home.