Clin Endosc.  2017 Jan;50(1):58-63. 10.5946/ce.2016.028.

Endoscopic Management of Gastrointestinal Leaks and Bleeding with the Over-the-Scope Clip: A Prospective Study

• Goenka MK
• Rai VK
• Goenka U
• Tiwary IK

• KMID: 2383491
• DOI: http://doi.org/10.5946/ce.2016.028

Abstract

BACKGROUND/AIMS
The over-the-scope clip (OTSC) is a device used for endoscopic closure of perforations, leaks and fistulas, and for endoscopic hemostasis. To evaluate the clinical effectiveness and safety of OTSC.
METHODS
Between October 2013 and November 2015, 12 patients underwent OTSC placement by an experienced endoscopist. OTSC was used for the closure of gastrointestinal (GI) leaks and fistula in six patients, three of which were iatrogenic (esophageal, gastric, and duodenal) and three of which were inflammatory. In six patients, OTSC was used for hemostasis of non-variceal upper GI bleeding. Endoscopic tattooing using India ink was used to assist the accurate placement of the clip.
RESULTS
All subjects except one with a colonic defect experienced immediate technical success as well as long-term clinical success, during a mean follow-up of 6 weeks. Only one clip was required to close each of the GI defects and to achieve hemostasis in all patients. There were no misfirings or complications of clips. The procedure was well tolerated, and patients were hospitalized for an average of 8 days (range, 3 to 10). Antiplatelet therapy was continued in patients with GI bleeding.
CONCLUSIONS
In our experience, OTSC was safe and effective for the closure of GI defect and to achieve hemostasis of non-variceal GI bleeding.

Keyword

Ovesco; Over-the-scope clip; Fistula closure; Gastrointestinal hemorrhage

MeSH Terms

Colon
Fistula
Follow-Up Studies
Gastrointestinal Hemorrhage
Hemorrhage*
Hemostasis
Hemostasis, Endoscopic
Humans
India
Ink
Prospective Studies*
Tattooing
Treatment Outcome

Figure

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  Fig. 1. (A) Bleeding from Mallory-Weiss tear. (B) Ovesco clip deployed to control the bleeding. (C) Clip in situ after 2 days.

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  Fig. 2. (A) Forrest class 1b bleeding from a duodenal ulcer. (B) Ovesco clip deployed to close the bleeding point. (C) Clip in situ after 2 days with no rebleeding.

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  Fig. 3. (A) Endoscopic view of an iatrogenic nasojejunal tube-related duodenal perforation. (B) Closure by Ovesco clip. (C) The site 7 days after application of the clip.

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  Fig. 4. Iatrogenic esophageal-pleural fistula following bougie dilatation. (A) Fistula shown on computed tomography image. (B) Endoscopic image of esophageal opening of fistula. (C) Successful closure by Ovesco clip.

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