title: Multipurpose use of the over-the-scope-clip system ("Bear claw") in the gastrointestinal tract: Swiss experience in a tertiary center.
abstract: OBJECTIVE
  To evaluate the outcome of over-the-scope-clip system (OTSC) for endoscopic treatment of various indications in daily clinical practice in Switzerland.
  
  
  METHODS
  This prospective, consecutive case series was conducted at a tertiary care hospital from September 2010 to January 2014. Indications for OTSC application were fistulae, anastomotic leakage, perforation, unroofed submucosal lesion for biopsy, refractory bleeding, and stent fixation in the gastrointestinal (GI) tract. Primary technical success was defined as the adequate deployment of the OTSC on the target lesion. Clinical success was defined as resolution of the problem; for instance, no requirement for surgery or further endoscopic intervention. In cases of recurrence, retreatment of a lesion with a second intervention was possible. Complications were classified into those related to sedation, endoscopy, or deployment of the clip.
  
  
  RESULTS
  A total of 28 OTSC system applications were carried out in 21 patients [median age 64 years (range 42-85), 33% females]. The main indications were fistulae (52%), mostly after percutaneous endoscopic gastrostomy tube removal, and anastomotic leakage after GI surgery (29%). Further indications were unroofed submucosal lesions after biopsy, upper gastrointestinal bleeding, or esophageal stent fixation. The OTSC treatments were applied either in the upper (48%) or lower (52%) GI tract. The mean lesion size was 8 mm (range: 2-20 mm). Primary technical success and clinical success rates were 85% and 67%, respectively. In 53% of cases, the suction method was used without accessories (e.g., twin grasper or tissue anchor). No endoscopy-related or OTSC-related complications were observed.
  
  
  CONCLUSIONS
  OTSC is a useful tool for endoscopic closure of various GI lesions, including fistulae and leakages. Future randomized prospective multicenter trials are warranted.
authors.affiliation: Michael Christian Sulz, Reto Bertolini, Remus Frei, Gian-Marco Semadeni, Jan Borovicka, Christa Meyenberger, Division of Gastroenterology and Hepatology, 9007 Gallen, Switzerland.
authors.forename: Michael Christian
authors.initials: MC
authors.lastname: Sulz
authors.affiliation: Michael Christian Sulz, Reto Bertolini, Remus Frei, Gian-Marco Semadeni, Jan Borovicka, Christa Meyenberger, Division of Gastroenterology and Hepatology, 9007 Gallen, Switzerland.
authors.forename: Reto
authors.initials: R
authors.lastname: Bertolini
authors.affiliation: Michael Christian Sulz, Reto Bertolini, Remus Frei, Gian-Marco Semadeni, Jan Borovicka, Christa Meyenberger, Division of Gastroenterology and Hepatology, 9007 Gallen, Switzerland.
authors.forename: Remus
authors.initials: R
authors.lastname: Frei
authors.affiliation: Michael Christian Sulz, Reto Bertolini, Remus Frei, Gian-Marco Semadeni, Jan Borovicka, Christa Meyenberger, Division of Gastroenterology and Hepatology, 9007 Gallen, Switzerland.
authors.forename: Gian-Marco
authors.initials: GM
authors.lastname: Semadeni
authors.affiliation: Michael Christian Sulz, Reto Bertolini, Remus Frei, Gian-Marco Semadeni, Jan Borovicka, Christa Meyenberger, Division of Gastroenterology and Hepatology, 9007 Gallen, Switzerland.
authors.forename: Jan
authors.initials: J
authors.lastname: Borovicka
authors.affiliation: Michael Christian Sulz, Reto Bertolini, Remus Frei, Gian-Marco Semadeni, Jan Borovicka, Christa Meyenberger, Division of Gastroenterology and Hepatology, 9007 Gallen, Switzerland.
authors.forename: Christa
authors.initials: C
authors.lastname: Meyenberger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000601:surgery; D016154:Digestive System Fistula / Q000601:surgery; D020776:Endoscopes, Gastrointestinal; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D004867:Equipment Design; D005260:Female; D005767:Gastrointestinal Diseases / Q000175:diagnosis / Q000601:surgery*; D006471:Gastrointestinal Hemorrhage / Q000601:surgery; D016558:Hemostasis, Endoscopic / Q000295:instrumentation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D015607:Stents; D013525:Surgical Instruments; D013557:Switzerland; D062606:Tertiary Care Centers; D016896:Treatment Outcome
keywords: Bear claw; Endoscopic closure; Fistulae; Gastrointestinal lesion; Leakage; OTSC; Over-the-scope-clip system; Perforations