title: Over-the-scope clip placement for closure of gastrointestinal fistula, postoperative leaks and refractory gastrointestinal bleed.
abstract: BACKGROUND
  The over-the-scope clip (OTSC) has been successfully used in the closure of fistula, perforation, dehiscence, and endoscopic hemostasis. We describe our experience with the OTSC application.
  
  
  METHODS
  Between April 2014 and April 2015, seven patients underwent OTSC application. In four patients, OTSC was applied for the closure of esophageal fistula, one had OTSC closure of persistent gastrocutaneous fistula after percutaneous endoscopic gastrostomy removal, and OTSC was applied in duodenum in two patients, for duodenal Dieulafoy's lesion after failed conventional endotherapy and massive rebleed in one and duodenal perforation in another.
  
  
  RESULTS
  All procedures had technical success with no immediate complication related to OTSC application. Patients were followed up for every month with mean duration of follow up 10.2 months. One patient with bronchoesophageal fistula had development of another fistulous opening above the site of OTSC placement, which was successfully closed with another OTSC. One patient had superficial esophageal wall ulcer opposite the OTSC but it healed spontaneously.
  
  
  CONCLUSIONS
  OTSC provided safe and successful closure in a number of settings.
authors.affiliation: Institute of Digestive and Hepatobiliary Sciences, Medanta The Medicity, CH. Baktawar Singh Road, Sector 38, Near Rajiv Chowk, Islampur Colony, Gurgaon, 122 001, India.
authors.forename: Mukesh
authors.initials: M
authors.lastname: Nasa
authors.affiliation: Institute of Digestive and Hepatobiliary Sciences, Medanta The Medicity, CH. Baktawar Singh Road, Sector 38, Near Rajiv Chowk, Islampur Colony, Gurgaon, 122 001, India.
authors.forename: Zubin Dev
authors.initials: ZD
authors.lastname: Sharma
authors.affiliation: Institute of Digestive and Hepatobiliary Sciences, Medanta The Medicity, CH. Baktawar Singh Road, Sector 38, Near Rajiv Chowk, Islampur Colony, Gurgaon, 122 001, India.
authors.forename: Narendra S
authors.initials: NS
authors.lastname: Choudhary
authors.affiliation: Institute of Digestive and Hepatobiliary Sciences, Medanta The Medicity, CH. Baktawar Singh Road, Sector 38, Near Rajiv Chowk, Islampur Colony, Gurgaon, 122 001, India.
authors.forename: Gaurav
authors.initials: G
authors.lastname: Patil
authors.affiliation: Institute of Digestive and Hepatobiliary Sciences, Medanta The Medicity, CH. Baktawar Singh Road, Sector 38, Near Rajiv Chowk, Islampur Colony, Gurgaon, 122 001, India. purirajesh69@gmail.com.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Puri
authors.affiliation: Institute of Digestive and Hepatobiliary Sciences, Medanta The Medicity, CH. Baktawar Singh Road, Sector 38, Near Rajiv Chowk, Islampur Colony, Gurgaon, 122 001, India.
authors.forename: Randhir
authors.initials: R
authors.lastname: Sud
mesh_terms: D000328:Adult; D000368:Aged; D057868:Anastomotic Leak / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D004937:Esophageal Fistula / Q000601:surgery*; D005260:Female; D005402:Fistula / Q000209:etiology / Q000601:surgery*; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000601:surgery*; D005774:Gastrostomy / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D012871:Skin Diseases / Q000601:surgery*; D013272:Stomach Diseases / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Bronchoesophageal fistula; Dieulafoy’s lesion; Endoscopic hemostasis; Gastrocutaneous fistula; Postoperative leak