Removal of an over-the-scope clip using the over-the-scope clip-removal system before performing polypectomy of the recurrent polyp

We present the case of a 64-year-old woman with no significant past medical history who was found during a screening colonoscopy to have a 45-mm sessile polyp at the hepatic angle. The initial resection attempt was complicated by massive spurting bleeding, which was controlled by adrenaline injection and the application of eight hemoclips. During the next colonoscopy, we observed adenomatous tissue with significant fibrosis and decided to perform endoscopic full-thickness resection (EFTR) with a “close and cut” technique using a 14/6 t over-the-scope (OTS) clip (Ovesco Endoscopy AG, Tübingen, Germany) [1] [2]. This resection was performed without any complications and the patient was discharged after 24 hours.

At follow-up colonoscopy, performed after 6 months, we observed adenomatous tissue with low grade dysplasia that was confirmed histologically growing around the clip ([Fig. 1]). Therefore, we decided to remove the OTS clip and make a new attempt to resect the adenoma. We used a specific OTS clip-removal system (remOVE; Ovesco Endoscopy AG) to cut the clip [3] [4]; however, because of tissue overgrowing across the thinner area of the OTS clip, it was necessary to cut it into four pieces ([Fig. 2]; [Video 1]). We then excluded perforation or any other complication and performed a piecemeal resection, achieving resection by electrocoagulation with the tip of a snare. The patient was discharged after a couple of hours of observation. The histology of the sample showed chronic inflammatory changes without adenomatous tissue.

Fig. 1 Endoscopic image showing the over-the-scope clip with adenomatous tissue growing around it.

Fig. 2 Diagram of over-the-scope clip with four marks showing where the removal device was applied.

Video 1 Removal of an over-the-scope (OTS) clip using the OTS clip-removal system before polypectomy of the recurrent polyp is performed.

The OTS clip-removal system is a safe technique for removing OTS clips and can be combined with a new attempt at endoscopic mucosal resection without complications.

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Competing interests

The authors declare that they have no conflict of interest.

• References

• 1 Albrecht H, Raithel M, Braun A. et al. Endoscopic full-thickness resection (EFTR) in the lower gastrointestinal tract. Tech Coloproctol 2019; 23: 957-963
• 2 Bisogni D, Talamucci L, Rossi M. et al. Endoscopic full-thickness resection with the full-thickness resection device (FTRD) for “difficult to resect” colonic lesions. A single-center experience. Ann Ital Chir 2020; 91: 486-493
• 3 Caputo A, Schmidt A, Caca K. et al. Efficacy and safety of the remOVE System for OTSC and FTRD clip removal: data from a PMCF analysis. Minim Invasive Ther Allied Technol 2018; 27: 138-142
• 4 Schmidt A, Riecken B, Damm M. et al. Endoscopic removal of over-the-scope clips using a novel cutting device: a retrospective case series. Endoscopy 2014; 46: 762-766

Publication History

Article published online:
14 November 2022