title: First-line endoscopic treatment with OTSC in patients with high-risk non-variceal upper gastrointestinal bleeding: preliminary experience in 40 cases.
abstract: OBJECTIVE
  The over-the-scope clip (OTSC; Ovesco, Tübingen, Germany) is a novel endoscopic clipping device designed for tissue approximation. The device has been used in the closure of fistulas and perforations. We hereby report a series of patients with high-risk non-variceal upper gastrointestinal bleeding (NVUGIB) lesions in whom OTSCs were used as first-line endoscopic treatment.
  
  
  METHODS
  We prospectively collected and retrospectively analysed data over a period of 12 months from October 2013 to November 2014 from all consecutive patients who underwent emergency endoscopy for acute severe high-risk NVUGIB and were treated with OTSC as primary first-line therapy.
  
  
  RESULTS
  We included forty consecutive patients with mean age 69 years (range 25-94 years). All patients were treated with the non-traumatic version of the OTSC system (23 with the 11 mm version and 17 with the 12 mm version). Indications for OTSC treatment included gastric ulcer with large vessel (Forrest IIa) (n = 8, 20 %), duodenal ulcer (Forrest Ib) (n = 7, 18 %), duodenal ulcer with large vessel (Forrest IIa) (n = 6, 15 %), Dieulafoy's lesion (n = 6, 15 %) and other secondary indications (n = 13, 32 %). Technical success and primary haemostasis were achieved in all patients (100 %). No re-bleeding, need for surgical or radiological embolization treatment or other complications were observed during the follow-up period of 30 days.
  
  
  CONCLUSIONS
  We conclude OTSC placement as a first-line endoscopic treatment seems to be effective, safe and easy to perform and should be considered in patients with high-risk NVUGIB lesions.
authors.affiliation: Digestive Endoscopy Unit-Northern Area, Ospedale di Carpi, Azienda USL di Modena, Via G. Molinari, 2, 41012, Carpi, Italy. mauromanno@gmail.com.
authors.forename: Mauro
authors.initials: M
authors.lastname: Manno
authors.affiliation: Digestive Endoscopy Unit-Northern Area, Ospedale di Carpi, Azienda USL di Modena, Via G. Molinari, 2, 41012, Carpi, Italy.
authors.forename: Santi
authors.initials: S
authors.lastname: Mangiafico
authors.affiliation: Gastroenterology and Digestive Endoscopy Unit, Nuovo Ospedale Civile S. Agostino-Estense, Baggiovara di Modena, MO, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Caruso
authors.affiliation: Digestive Endoscopy Unit-Northern Area, Ospedale di Carpi, Azienda USL di Modena, Via G. Molinari, 2, 41012, Carpi, Italy.
authors.forename: Carmelo
authors.initials: C
authors.lastname: Barbera
authors.affiliation: Gastroenterology and Digestive Endoscopy Unit, Nuovo Ospedale Civile S. Agostino-Estense, Baggiovara di Modena, MO, Italy.
authors.forename: Helga
authors.initials: H
authors.lastname: Bertani
authors.affiliation: Gastroenterology and Digestive Endoscopy Unit, Nuovo Ospedale Civile S. Agostino-Estense, Baggiovara di Modena, MO, Italy.
authors.forename: Vincenzo G
authors.initials: VG
authors.lastname: Mirante
authors.affiliation: Digestive Endoscopy Unit-Northern Area, Ospedale di Carpi, Azienda USL di Modena, Via G. Molinari, 2, 41012, Carpi, Italy.
authors.forename: Flavia
authors.initials: F
authors.lastname: Pigò
authors.affiliation: Gastroenterology and Digestive Endoscopy Unit, Queens Medical Centre, Derby Road, Nottingham, UK.
authors.forename: Khanna
authors.initials: K
authors.lastname: Amardeep
authors.affiliation: Gastroenterology and Digestive Endoscopy Unit, Nuovo Ospedale Civile S. Agostino-Estense, Baggiovara di Modena, MO, Italy.
authors.forename: Rita
authors.initials: R
authors.lastname: Conigliaro
mesh_terms: D000328:Adult; D004381:Duodenal Ulcer / Q000150:complications; D016099:Endoscopy, Gastrointestinal / Q000295:instrumentation* / Q000379:methods; D004867:Equipment Design; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000601:surgery*; D016558:Hemostasis, Endoscopic / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012306:Risk; D013276:Stomach Ulcer / Q000150:complications; D013525:Surgical Instruments; D016896:Treatment Outcome
keywords: Endoscopy upper GI tract; Non-variceal gastrointestinal bleeding; Over-the-scope clip; Ulcers peptic and other