Endoscopy 2018; 50(04): S6-S7
DOI: 10.1055/s-0038-1637042
ESGE Days 2018 oral presentations
20.04.2018 – GI bleeding
Georg Thieme Verlag KG Stuttgart · New York

SINGLE-CENTER EXPERIENCE ON OVER-THE-SCOPE-CLIP (OTSC) AS FIRST LINE THERAPY IN NON-VARICEAL UPPER GASTROINTESTINAL BLEEDING

P Soriani
1   Ramazzini Hospital, Digestive Endoscopy Unit, Carpi (MO), Italy
,
VG Mirante
1   Ramazzini Hospital, Digestive Endoscopy Unit, Carpi (MO), Italy
,
C Barbera
1   Ramazzini Hospital, Digestive Endoscopy Unit, Carpi (MO), Italy
,
T Gabbani
1   Ramazzini Hospital, Digestive Endoscopy Unit, Carpi (MO), Italy
,
L Miglioli
1   Ramazzini Hospital, Digestive Endoscopy Unit, Carpi (MO), Italy
,
M Manno
1   Ramazzini Hospital, Digestive Endoscopy Unit, Carpi (MO), Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

 

Aims:

The over-the-scope clip (OTSC; Ovesco, Tubingen, Germany) is an endoscopic clipping device designed for tissue approximation. This tool has been used in the closure of fistulas and perforations. We hereby report a series of patients with high-risk non-variceal upper gastrointestinal bleeding (NVUGIB) lesions in whom OTSCs were used as first-line endoscopic treatment. We prospectively collected and retrospectively analysed data over a period of 48 months from November 2013 to October 2017 from all consecutive patients who underwent emergency endoscopy for acute severe high-risk NVUGIB and were treated with OTSC as primary first-line therapy.

Methods:

We included 51 consecutive patients (41 M, 10 F) (mean age 70 ± 17 years, range 24 – 94 years). All patients were treated with the non-traumatic version of the OTSC system (35 with the 11 mm version and 16 with the 12 mm version).

Results:

Indications for OTSC treatment included gastric ulcer with spurting bleeding (Forrest Ia) (n = 5, 9.8%), with oozing bleeding (Forrest Ib) (n = 6, 11.8%), with large vessel (Forrest IIa) (n = 8, 15.7%), duodenal ulcer with spurting bleeding (Forrest Ia) (n = 1, 2%), with oozing bleeding (Forrest Ib) (n = 8, 15.7%), duodenal ulcer with large vessel (Forrest IIa) (n = 9, 17.6%), with adherent clot (Forrest IIb) (n = 1, 2%), Dieulafoy's lesion (n = 7, 13.7%), Mallory Weiss (n = 3, 5.9%), gastro-jejunal anastomotic lesion (n = 3, 5.9%). Technical success and primary haemostasis were achieved in all patients (100%). However, 2 rebleeding episodes occurred: 1 in a case of a duodenal Dieulafoy's lesion, subsequently resolved using argon plasma coagulation (APC 2, Erbe Elektromedizin GmbH); the other in a case of large gastric ulcer Forrest Ib, treated using hemostatic powder (Hemospray®, Cook Medical Inc.; Bloomington, Ind.). No need for surgical or radiological embolization treatment or complications were observed during 30 days follow-up.

Conclusions:

In conclusion, OTSC placement as first-line endoscopic treatment seems to be effective, safe and easy to perform and should be considered in patients with high- risk NVUGIB lesions.