Multipurpose use of the over-the-scope-clip system (“Bear claw”) in the gastrointestinal tract: Swiss experience in a tertiary center

Table 1 Demographic data, indications, lesion sizes, interventions and successes/outcomes of 21 patients treated with over-the-scope-clip

No.	Sex	Age (yr)	Indication	Lesion size (mm)	OTSC type	Twin grasper (T)Anchor (A)	Technical success	Clinical success	2nd OTSC	Clinical success after 2nd OTSC
1	M	59	Right-sided colocutaneous fistula with abscess	5	14/6	-	Y	Y	N
2	M	42	Fibrotic cardiac fistula with recurrent infections after gastric sleeve surgery, 21 mo prior	2	12/3a 12/6a	T	N	N	12/6a	Y
3	M	70	2 anastomotic leakages 3 wk after low anterior resection of adenocarcinoma	Each 20	3 clips	A	N		Same session	Y
4	F	63	PEG gastrostomy closed due to secondary peritonitis	5	1 clip	A	Y	Y	N
5	M	71	Ileorectal anastomotic leakage after colectomy 6 mo prior, due to stenosing chronic diverticulitis	7	14/6	A	Y	N	N
6	F	62	Anastomotic leakage after right hemicolectomy	3	12/6a	-	Y	Y	N
7	M	60	Anastomotic leakage 6 wk after low anterior resection	5	12/6a	A	Y	Y	N
8	F	59	2 rectoabdominocutaneous fistulae after small and large bowel resections with rectal stump in Crohn’s disease	Each 2 × 2	14/6a	A	Y	N	14/6a	Y
9	M	55	Gastrocutaneous fistula after PEG tube removal 7 days prior	20 × 5	-	-	Not amenable due to esophageal stenosis
10	F	47	Gastrocutaneous fistula after gastric sleeve resection	6	2 × 11/6a	A	Y	Y	N
11	M	45	Infected gastrocutaneous fistula after PEG tube removal	2	11/6a	-	Y	Y	N
12	F	67	Fistula of the rectum and abscess in the small pelvis after surgery	8	12/6a	T + A	Y	N	2 × 12/3a	N
13	M	84	Anastomotic leakage after ileosigmoidostomy	8	12/6t	A	Y	Y	N
14	M	51	Endoscopic unroofing of a submucosal antral tumor for biopsy	10	12/6gc	-	Y	Y	N
15	F	82	Infected gastrocutaneous fistula after PEG tube removal	3	12/6gc	-	Y	Y	N
16	M	85	Gastrocolic migration of PEG tube	4	12/6a	-	Y	Y	N
17	M	63	Anastomotic leakage after colorectal resection	5	12/6t	-	Y	Y	N
18	M	59	Endoscopic unroofing of a submucosal gastric tumor for biopsy (Figure 3)	15	12/6gc	-	Y	Y	N
19	F	81	Dieulafoy lesion, Forrest Ia; known achalasia	8	12/6t	-	Y	Y	N
20	M	68	Fixation of esophageal stent	-	11/6a	-	Y	Y	N
21	M	71	Fistula between colon and rectal stump after Hartmann procedure due to rectal cancer	15	12/6a	A	Y	N	Y	N

No. 12: In the first session, the anal stenosis did not allow passage of the colonoscope with the mounted OTSC system; No. 16: Combined with colonoscopic removal of the PEG tube; No. 20: After endoscopic removal of the dislocated esophageal stent. History of aortoesophageal fistula, mediastinitis, and thoracic endovascular aortic repair 1 mo prior; No. 21: Further failure with 12/6a and 12/6gc. OTSC: Over-the-scope-clip; PEG: Percutaneous endoscopic gastrostomy; M: Male; F: Female.

Table 2 Demographic data, indications, lesion size and localization of the over-the-scope-clip applications

Characteristics	Patients (n, unless otherwise indicated)
Number of patients (% females)	21 (33%)
Age, median (range), yr	64 (42-85)
Indications Fistulae (OTSC application) Colon After PEG tube removal (colon or stomach) Stomach after surgery Anastomotic leakage Unroofed submucosal lesion after biopsy Upper gastrointestinal bleeding Esophageal stent fixation	11 4 5 2 6 2 1 1
Localization Upper GI tract Lower GI tract	10 11
Lesion size, mean (range), mm	8 (2-20)

OTSC: Over-the-scope-clip; PEG: Percutaneous endoscopic gastrostomy.

Table 3 Outcome data of the 28 applied over-the-scope-clip in 21 patients, technical and clinical success, use of accessories, complications n (%)

Outcome	Value
Number of OTSC applications	28
Primary technical success Permanent clinical success Clinical success after 2nd intervention	18 (85) 14 (67) 3 out of 5 (60)
Use of accessories Twin grasper, n Tissue anchor, n	10 patients (47) 2 9
Complications, n	0

Please note that in one case Twin grasper and Tissue anchor were both used. OTSC: Over-the-scope-clip.