Gilad Shapira, MD1, Manoj Kumar, MD2, Yazan Fahmawi, MD2, Meir Mizrahi, MD3
1University of South Alabama College of Medicine, Mobile, AL; 2University of South Alabama, Mobile, AL; 3University of South Alabama College of Medicine, Spanish Fort, AL
Introduction: Upper Gastrointestinal Hemorrhage (UGIH) remains a common problem in modern day endoscopy. Etiologies of UGIH include variceal, nonvariceal, neoplastic, vascular malformation, and iatrogenic among others. Endoscopic hemostasis is typically achieved by through the scope (TTS) clips, epinephrine injections, ablation techniques, coils and glues and self-expandable stents. Despite having multiple tools for bleeding control, rebleeding risk remains high among single vessel ulcers and larger lesions. Here we present a case where traditional hemostasis methods failed, and an over-the-scope clip (OTSC) was used as salvage/rescue hemostasis therapy.
Case Description/Methods: 45-year-old asian Male with a history of cirrhosis secondary to alcohol presented with jaundice and melena with a hemoglobin of 5.9 gm/dl. EGD showed severe duodenitis. A side viewing duodenoscope showed a large, cratered duodenal bulb ulcer with a visible vessel. Epinephrine was injected and 5 hemoclips were placed. Despite this, there was still active oozing of blood. All the hemoclips were removed with snare. OTSC System was loaded onto a standard gastroscope and advanced to the lesion. Target tissue was sucked into the cap and OTSC® clip was released by turning the hand wheel. The clip closed itself and firmly anchored the tissue resulting in complete hemostasis. Proton pump inhibitors were continued and follow up endoscopy at 1 month showed healed ulcer site with clip in place.
Discussion: TTS clip can sometimes be not enough for UGI bleeding treatment especially during active bleeding, use in ulcers with a fibrotic base, or when the bleeding lesion is in a difficult-to-access anatomic location (e.g., gastric lesser curve or cardia, posterior duodenal wall). While OTSC have been well established in leaks, perforations, and fistulas, their role in UGIH is evolving. Several randomized trials comparing OTSC with conventional endoscopic hemostasis therapies are ongoing and results are awaiting, however our case reiterates that OTSC platform should be available and be part of endoscopic hemostasis armamentarium.
Citation: Gilad Shapira, MD; Manoj Kumar, MD; Yazan Fahmawi, MD; Meir Mizrahi, MD. P0444 - DOMINANT CLAW CONTROL: ROLE OF OTSC CLIP AS SALVAGE HEMOSTASIS THERAPY. Program No. P0444. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.