Endoscopic removal of over-the-scope clips using a novel cutting device: a retrospective case series

Background and study aims: Over-the-scope clips (OTSCs; Ovesco Endoscopy, Tübingen, Germany) are extensively used for treatment of gastrointestinal perforations, leakages, fistulas, and bleeding. In this report, a new method of removing OTSCs using a prototype bipolar cutting device is described.

Patients and methods: A total of 11 patients underwent endoscopic removal of an OTSC. The OTSC was cut at two opposing sites by a prototype device (DC ClipCutter; Ovesco Endoscopy). The remaining clip fragments were extracted using a standard forceps.

Results: Mean procedure time was 47 minutes (range 35 – 75 minutes). Cutting of the OTSC at two opposing sites was successful in all cases (100 %). Complete retrieval of all clip fragments was possible in 10 patients (91 %). The overall success rate for cutting and complete removal of the clip was 91 %. No major complications were observed.

Conclusions: Removal of OTSCs with the prototype device was feasible and effective. The device may be valuable for OTSC removal in emergency as well as elective indications.

• References

• 1 Weiland T, Fehlker M, Gottwald T et al. Performance of the OTSC System in the endoscopic closure of iatrogenic gastrointestinal perforations: a systematic review. Surg Endosc 2013; 27: 2258-2274
• 2 Weiland T, Fehlker M, Gottwald T et al. Performance of the OTSC System in the endoscopic closure of gastrointestinal fistulae – a meta-analysis. Minim Invasive Ther Allied Technol 2012; 21: 249-258
• 3 Mennigen R, Colombo-Benkmann M, Senninger N et al. Endoscopic closure of postoperative gastrointestinal leakages and fistulas with the Over-the-Scope Clip (OTSC). J Gastrointest Surg 2013; 17: 1058-1065
• 4 Albert JG, Friedrich-Rust M, Woeste G et al. Benefit of a clipping device in use in intestinal bleeding and intestinal leakage. Gastrointest Endosc 2011; 74: 389-397
• 5 Kirschniak A, Subotova N, Zieker D et al. The Over-The-Scope Clip (OTSC) for the treatment of gastrointestinal bleeding, perforations, and fistulas. Surg Endosc 2011; 25: 2901-2905
• 6 von Renteln D, Rudolph HU, Schmidt A et al. Endoscopic closure of duodenal perforations by using an over-the-scope clip: a randomized, controlled porcine study. Gastrointest Endosc 2010; 71: 131-138
• 7 Mönkemüller K, Peter S, Toshniwal J et al. Multipurpose use of the ‘bear claw’ (over-the-scope-clip system) to treat endoluminal gastrointestinal disorders. Dig Endosc 2013; [Epub ahead of print]
• 8 Schurr MO, Arezzo A, Ho CN et al. The OTSC clip for endoscopic organ closure in NOTES: device and technique. Minim Invasive Ther Allied Technol 2008; 17: 262-266
• 9 Manta R, Galloro G, Mangiavillano B et al. Over-the-scope clip (OTSC) represents an effective endoscopic treatment for acute GI bleeding after failure of conventional techniques. Surg Endosc 2013; 27: 3162-3164
• 10 Kratt T, Stüker D, Graepler F et al. The Over-The-Scope-Clip System (OTSC®) for the treatment of severe GI bleeding: experience from clinical use in 83 cases. Z Gastroenterol 2013; 51: K269
• 11 Schlag C, Wilhelm D, von Delius S et al. EndoResect study: endoscopic full-thickness resection of gastric subepithelial tumors. Endoscopy 2013; 45: 4-11
• 12 von Renteln D, Rösch T, Kratt T et al. Endoscopic full-thickness resection of submucosal gastric tumors. Dig Dis Sci 2012; 57: 1298-1303
• 13 Fähndrich M, Sandmann M, Heike M. Removal of over the scope clips (OTSC) with an Nd:YAG Laser. Z Gastroenterol 2011; 49: 579-583
• 14 Arezzo A, Bullano A, Fischer H et al. The way to remove an over-the-scope-clip (with video). Gastrointest Endosc 2013; 77: 974-975
• 15 Neumann H, Diebel H, Mönkemüller K et al. Description of a new, endoscopic technique to remove the over-the-scope-clip in an ex vivo porcine model (with video). Gastrointest Endosc 2012; 76: 1009-1013