Published online Dec 28, 2015. doi: 10.3748/wjg.v21.i48.13587
Peer-review started: April 16, 2015
First decision: June 19, 2015
Revised: June 25, 2015
Accepted: August 30, 2015
Article in press: August 31, 2015
Published online: December 28, 2015
Processing time: 253 Days and 10 Hours
This paper reports our experience with a new over-the-scope clip in the setting of recurrent bleeding and oesophageal fistula. We treated five patients with the over-the-scope Padlock Clip™. It is a nitinol ring, with six inner needles preassembled on an applicator cap, thumb press displaced by the Lock-It™ delivery system. The trigger wire is located alongside the shaft of the endoscope, and does not require the working channel. Three patients had recurrent bleeding lesions (bleeding rectal ulcer, post polypectomy delayed bleeding and duodenal Dieulafoy’s lesion) and two patients had a persistent respiratory-esophageal fistula. In all patients a previous endoscopic attempt with standard techniques had been useless. All procedures were conducted under conscious sedation but for one patient that required general anaesthesia due to multiple comorbidities. We used one Padlock Clip™ for each patient in a single session. Simple suction was enough in all of our patients to obtain tissue adhesion to the instrument tip. A remarkably short application time was recorded for all cases (mean duration of the procedure: 8 min). We obtained technical and immediate clinical success for every patient. No major immediate, early or late (within 24 h, 7 d or 4 wk) adverse events were observed, over follow-up durations lasting a mean of 109.4 d. One patient, treated for duodenal bulb bleeding from a Dieulafoy's lesion, developed signs of mild pancreatitis 24 h after the procedure. The new over-the-scope Padlock Clip™ seems to be simple to use and effective in different clinical settings, particularly in “difficult” scenarios, like recurrent bleeding and respiratory-oesophageal fistulas.
Core tip: We report our experience with the novel over-the-scope Padlock Clip™, applied in five patients in the clinical settings of oesophageal fistulas and refractory gastrointestinal bleeding. The Padlock ClipTM has shown reliable closure of wall defects in a porcine survival study, although clinical usage remains limited. As yet, there are no published data regarding its application in the management of non-variceal gastrointestinal bleeding. We provide a comprehensive iconographic documentation and two videos showing its application. We also accurately describe the device and its release system, pointing out the differences with the well-known over-the-scope clip system.