title: Use of the over-the-scope clip to treat massive bleeding at the transitional zone of the anal canal: a case series.
abstract: OBJECTIVE
  Endoscopic treatment of anorectal bleeding can be challenging. We report use of the endoscopic over-the-scope clip (OTSC) to treat massive bleeding from the transitional zone of the anorectum. The aim of this retrospective study was to assess the clinical outcome and efficacy of the OTSC and to describe the technique of its use in acute severe bleeding occurring at the transitional zone of the anorectum.
  
  
  METHODS
  We treated 5 consecutive patients (age range, 36-79 years, 5 men) with severe bleeding from the transitional zone of the anorectum caused by hemorrhoid therapy, digital trauma, and a Dieulafoy lesion. We analyzed the efficacy, safety, and outcome of endoscopic treatment using the OTSC.
  
  
  RESULTS
  Primary hemostasis was successfully achieved in all the patients using a single OTSC. The OTSC deployment technique was adapted from the endoscopic band ligation of hemorrhoids. There was no immediate or late rebleeding. We observed that there were no adverse events from OTSC placement in the anorectum.
  
  
  CONCLUSIONS
  This case series provides evidence that OTSCs may be effective in controlling bleeding from the transitional zone of the anorectum. Although use of OTSCs for bleeding elsewhere in the GI tract has been described, this case series is the first to show its application in the transitional zone of the anorectum.
authors.affiliation: VA Health Systems, Palo Alto, California, USA, and Stanford University, Stanford, California, USA; Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore; National Cancer Center Singapore and Duke-NUS Graduate Medical School, Singapore.
authors.forename: Roy
authors.initials: R
authors.lastname: Soetikno
authors.affiliation: Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore.
authors.forename: Ravishankar
authors.initials: R
authors.lastname: Asokkumar
authors.affiliation: VA Health Systems, Palo Alto, California, USA, and Stanford University, Stanford, California, USA.
authors.forename: Davis
authors.initials: D
authors.lastname: Sim
authors.affiliation: VA Health Systems, Palo Alto, California, USA, and Stanford University, Stanford, California, USA.
authors.forename: Tohru
authors.initials: T
authors.lastname: Sato
authors.affiliation: VA Health Systems, Palo Alto, California, USA, and Stanford University, Stanford, California, USA.
authors.forename: Tonya
authors.initials: T
authors.lastname: Kaltenbach
mesh_terms: D000328:Adult; D000368:Aged; D001004:Anus Diseases / Q000628:therapy*; D006471:Gastrointestinal Hemorrhage / Q000628:therapy*; D006484:Hemorrhoids / Q000628:therapy; D016558:Hemostasis, Endoscopic / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012002:Rectal Diseases / Q000628:therapy; D012189:Retrospective Studies; D013525:Surgical Instruments