title: The over-the-scope clip system--a novel technique for gastrocutaneous fistula closure: the first North American experience.
abstract: BACKGROUND
  The mainstay of therapy for gastrocutaneous (GC) fistulas has been surgical intervention. However, endoclips are currently used for management of perforations and fistulas but are limited by their ability to entrap and hold the tissue.
  
  
  OBJECTIVE
  To report the first North American experience with a commercially available over-the-scope clip (OTSC) device, a novel and new tool for the endoscopic entrapment of tissue for the closure of fistula and perforations.
  
  
  METHODS
  The present single-centre study was conducted at a tertiary referral academic gastroenterology unit and centre for advanced therapeutic endoscopy and involved patients referred for endoscopic treatment for the closure of a GC fistula. The OTSC device was mounted on the tip of the endoscope and passed into the stomach to the level of the fistula. The targeted site of the fistula was grasped with the tissue anchoring tripod and pulled into the cap with concomitant scope channel suction. Once the tissue was trapped in the cap, a 'bear claw' clip was deployed.
  
  
  RESULTS
  The patients recovered with fistula closure. No complication or recurrence was noted. Fistula sizes >1 cm, however, were difficult to close with the OTSC system. The length of stay of the bear claw clip at the fistula site is unpredictable, which may lead to incomplete closure of the fistula.
  
  
  CONCLUSIONS
  Closure of a GC fistula using a novel 'bear claw' clip system is feasible and safe.
authors.affiliation: Lenox Hill Hospital, New York, NY, USA. itskots@gmail.com
authors.forename: Truptesh H
authors.initials: TH
authors.lastname: Kothari
authors.forename: Gregory
authors.initials: G
authors.lastname: Haber
authors.forename: Niket
authors.initials: N
authors.lastname: Sonpal
authors.forename: Nithin
authors.initials: N
authors.lastname: Karanth
mesh_terms: D000369:Aged, 80 and over; D017577:Cutaneous Fistula / Q000503:physiopathology / Q000601:surgery*; D004867:Equipment Design; D005260:Female; D005747:Gastric Fistula / Q000503:physiopathology / Q000601:surgery*; D020699:Gastroscopes / Q000639:trends*; D005773:Gastroscopy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods / Q000639:trends; D006801:Humans; D007902:Length of Stay; D013525:Surgical Instruments / Q000639:trends*; D016896:Treatment Outcome