title: Hemodynamic efficacy of the over-the-scope clip in an established porcine cadaveric model for spurting bleeding.
abstract: BACKGROUND
  Clip application has been proven to be effective for endoscopic hemostasis. There are limited bench data on the efficacy of the over-the-scope clip (OTSC) for the treatment of spurting GI hemorrhage. We evaluated the hemodynamic efficacy of the OTSC in an established bleeding model.
  
  
  OBJECTIVE
  To evaluate the hemodynamic efficacy of the OTSC in an established bleeding model.
  
  
  METHODS
  Prospective experimental trial with historical comparison.
  
  
  METHODS
  We tested the OTSC prospectively in a validated bleeding model by using the compact Erlangen Active Simulator for Interventional Endoscopy equipped with an upper GI organ package. The artificial blood circulation system of the simulator was connected to an arterial pressure transducer. Two investigators with different endoscopic experience (4000 and 10,000 endoscopies performed) participated. Each investigator treated 16 bleeding sites in the simulator with the OTSC by using only suction (n = 8) and a novel retraction device to grasp tissue (n = 8). Systemic pressures were recorded 1 minute before, during, and 1 minute after clip application to objectify the effects of clipping on the vessel diameter.
  
  
  METHODS
  Mean and maximum reduction in vessel diameter.
  
  
  RESULTS
  The application of the OTSC on the bleeding vessel led to a significant increase in systemic pressure (P < .001) and decreased vessel diameter (P < .001) independent of the endoscopic experience of the investigator. There was no difference in the decrease in vessel diameter based on the application technique (suction vs suction plus grasping). A historical comparison with our former trials demonstrated that the OTSC decreased the vessel diameter significantly more than other traditional endoclips.
  
  
  CONCLUSIONS
  Small sample size.
  
  
  CONCLUSIONS
  We could demonstrate the efficacy of the OTSC with increased hemodynamic efficiency compared with other endoscopic clip devices tested previously.
authors.affiliation: Department of Medicine 1, University of Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Naegel
authors.forename: Johannes
authors.initials: J
authors.lastname: Bolz
authors.forename: Yurdaguel
authors.initials: Y
authors.lastname: Zopf
authors.forename: Kai
authors.initials: K
authors.lastname: Matthes
authors.forename: Birk
authors.initials: B
authors.lastname: Mueller
authors.forename: Franz
authors.initials: F
authors.lastname: Kraus
authors.forename: Markus F
authors.initials: MF
authors.lastname: Neurath
authors.forename: Juergen
authors.initials: J
authors.lastname: Maiss
mesh_terms: D000818:Animals; D001794:Blood Pressure; D002102:Cadaver; D002983:Clinical Competence; D006471:Gastrointestinal Hemorrhage / Q000628:therapy*; D016558:Hemostasis, Endoscopic / Q000295:instrumentation* / Q000379:methods; D023421:Models, Animal; D011446:Prospective Studies; D013552:Swine