Observational Study
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World J Gastroenterol. Nov 21, 2014; 20(43): 16287-16292
Published online Nov 21, 2014. doi: 10.3748/wjg.v20.i43.16287
Multipurpose use of the over-the-scope-clip system (“Bear claw”) in the gastrointestinal tract: Swiss experience in a tertiary center
Michael Christian Sulz, Reto Bertolini, Remus Frei, Gian-Marco Semadeni, Jan Borovicka, Christa Meyenberger
Michael Christian Sulz, Reto Bertolini, Remus Frei, Gian-Marco Semadeni, Jan Borovicka, Christa Meyenberger, Division of Gastroenterology and Hepatology, 9007 Gallen, Switzerland
Author contributions: Sulz MC designed the study together with Frei R and Semadeni GM; all authors provided data; Sulz MC and Bertolini R analysed and interpreted the data and wrote the manuscript; Borovicka J and Meyenberger C interpreted the data, revised the manuscript and approved the final version.
Correspondence to: Michael Christian Sulz, MD, Division of Gastroenterology and Hepatology, Kantonsspital St. Gallen, Rorschacher Strasse 95, 9007 Gallen, Switzerland. michael.sulz@kssg.ch
Telephone: +41-71-4941245 Fax: +41-71-4942862
Received: May 16, 2014
Revised: June 21, 2014
Accepted: July 15, 2014
Published online: November 21, 2014
Processing time: 188 Days and 5 Hours
Abstract

AIM: 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.

CONCLUSION: OTSC is a useful tool for endoscopic closure of various GI lesions, including fistulae and leakages. Future randomized prospective multicenter trials are warranted.

Keywords: Over-the-scope-clip system; OTSC; Bear claw; Endoscopic closure; Gastrointestinal lesion; Perforations; Fistulae; Leakage

Core tip: In this prospective case series, we report the outcome of the over-the-scope-clip system (OTSC) in endoscopic treatment of various indications, including closing fistulae and repairing anastomotic leakages in daily clinical practice in Switzerland. The OTSCs (n = 28) were applied in 21 patients. Primary technical and clinical success rates were 85% and 67%, respectively. No complications were observed related to endoscopy or OTSC. OTSC is a useful tool for endoscopic closure of various gastrointestinal lesions.