title: Multipurpose use of the 'bear claw' (over-the-scope-clip system) to treat endoluminal gastrointestinal disorders.
abstract: OBJECTIVE
  The 'bear-claw' or over-the-scope-clip system (OTSC; Ovesco Endoscopy, Tübingen, Germany) is a new clipping device developed for closure of large luminal gastrointestinal (GI) defects. The aim of the present study was to evaluate the clinical outcomes of patients treated with the OTSC.
  
  
  METHODS
  The present study was an observational, open-label, retrospective, single-arm case series conducted at two hospitals with tertiary care endoscopy. It involved 20 clip applications in 16 patients (median age 65.8 years [range 51-90 years], seven women) with GI defects from fistulas and anastomotic dehiscence and peptic ulcer bleeding.
  
  
  RESULTS
  The range of indications included gastrointestinal bleeding (n=6), gastrocutaneous fistulas (n=3), esophagotracheal and/or esophagopleural fistulae (n=3), resection ofsubmucosal tumor (n=2), stent fixation (n=1), and anastomotic leak after esophagectomy (n=1). The overall success rate for the OTSC device was 75% (12 out of 16 patients). The overall per case success rate was 70% (14 of 20 applications). Mean follow up was 10 months (range 1-10). There were no complications (0%) related to endoscopy, sedation or application of the clipping device.
  
  
  CONCLUSIONS
  The OTSC system is a useful device in a variety of clinical scenarios including the management of larger GI leaks and fistulas, GI bleeding, full-thickness resection of tumors, and stent anchoring, even in very old and frail patients.
authors.affiliation: Division of Gastroenterology and Hepatology, Basil Hirschowitz Endoscopic Center of Excellence; Department of Internal Medicine, Gastroenterology and Infectious Diseases, Marienhospital, Bottrop, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Mönkemüller
authors.forename: Shajan
authors.initials: S
authors.lastname: Peter
authors.forename: Jay
authors.initials: J
authors.lastname: Toshniwal
authors.forename: Daniel
authors.initials: D
authors.lastname: Popa
authors.forename: Marzena
authors.initials: M
authors.lastname: Zabielski
authors.forename: Richard D
authors.initials: RD
authors.lastname: Stahl
authors.forename: Jayapal
authors.initials: J
authors.lastname: Ramesh
authors.forename: C Mel
authors.initials: CM
authors.lastname: Wilcox
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000295:instrumentation / Q000379:methods; D015331:Cohort Studies; D020776:Endoscopes, Gastrointestinal; D016099:Endoscopy, Gastrointestinal / Q000295:instrumentation* / Q000379:methods; D004867:Equipment Design; D004869:Equipment Safety; D004937:Esophageal Fistula / Q000175:diagnosis / Q000601:surgery; D005260:Female; D005747:Gastric Fistula / Q000175:diagnosis / Q000601:surgery; D005767:Gastrointestinal Diseases / Q000175:diagnosis* / Q000601:surgery*; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000601:surgery; D006488:Hemostasis, Surgical / Q000295:instrumentation / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D015607:Stents; D013525:Surgical Instruments; D016896:Treatment Outcome
keywords: clip; endoscopic closure; fistula; over-the-scope clip; peptic ulcer bleeding; perforation