Endoscopic Management of Gastrointestinal Leaks and Bleeding with the Over-the-Scope Clip: A Prospective Study.
OBJECTIVE
The over-the-scope clip (OTSC) is a device used for endoscopic closure of perforations, leaks and fistulas, and for endoscopic hemostasis. To evaluate the clinical effectiveness and safety of OTSC.


METHODS
Between October 2013 and November 2015, 12 patients underwent OTSC placement by an experienced endoscopist. OTSC was used for the closure of gastrointestinal (GI) leaks and fistula in six patients, three of which were iatrogenic (esophageal, gastric, and duodenal) and three of which were inflammatory. In six patients, OTSC was used for hemostasis of non-variceal upper GI bleeding. Endoscopic tattooing using India ink was used to assist the accurate placement of the clip.


RESULTS
All subjects except one with a colonic defect experienced immediate technical success as well as long-term clinical success, during a mean follow-up of 6 weeks. Only one clip was required to close each of the GI defects and to achieve hemostasis in all patients. There were no misfirings or complications of clips. The procedure was well tolerated, and patients were hospitalized for an average of 8 days (range, 3 to 10). Antiplatelet therapy was continued in patients with GI bleeding.


CONCLUSIONS
In our experience, OTSC was safe and effective for the closure of GI defect and to achieve hemostasis of non-variceal GI bleeding.
Institute of Gastrosciences, Apollo Gleneagles Hospitals, Kolkata, India.
Mahesh Kumar
MK
Goenka
Institute of Gastrosciences, Apollo Gleneagles Hospitals, Kolkata, India.
Vijay Kumar
VK
Rai
Department of Imaging and Interventional Radiology, Apollo Gleneagles Hospitals, Kolkata, India.
Usha
U
Goenka
Institute of Gastrosciences, Apollo Gleneagles Hospitals, Kolkata, India.
Indrajit Kumar
IK
Tiwary
Fistula closure; Gastrointestinal hemorrhage; Over-the-scope clip; Ovesco