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Surgical Endoscopy
Published in: Surgical Endoscopy 8/2015

01-08-2015 | New Technology

DC current pulses for OTSC clip fragmentation: technology and experimental study

Authors: Sebastian Schostek, C. N. Ho, M. Melbert, M. Krautwald, A. Caputo, G. Parisi, M. Wehrmann, T. Gottwald, M. O. Schurr

Published in: Surgical Endoscopy | Issue 8/2015

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Abstract

Background

The OTSC clip is used in endoscopic management of gastrointestinal lesions. In rare cases, the removal of the OTSC clip might be desirable. The objective of the study is to investigate feasibility, efficacy, and safety of a novel endoscopic instrument system for removal of the OTSC clip.

Methods

The study series has been conducted in a porcine model. Clip removal is performed with a prototype instrumentation that is designed to locally melt the clip by applying an electrical current pulse onto the clip structure. This system has been evaluated in an animal study (n = 10) in a pig model. A cap prototype with an elongated sleeve has been used for extraction of the OTSC clip fragments.

Results

23 of 24 implanted OTSC clips were successfully opened by applying in a total of 74 current pulses. Superficial mucosal coagulation marks were observed in 14 of the 24 application sites. No other findings such as hemorrhage, deep thermal wall lesions, or perforation were observed.

Conclusions

The study confirms the effectiveness and safety of the proposed endoscopic removal technique. Safe extraction of the clip fragments was feasible with an elongated sleeve at the distal cap. Limitations of the methods are the animal model and the experimental nature of the prototype instrumentation.
Literature
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Manta R, Galloro G, Mangiavillano B et al (2013) Over-the-scope clip (OTSC) represents an effective endoscopic treatment for acute GI bleeding after failure of conventional techniques. Surg 27:3162–3164
2.
Weiland T, Fehlker M, Gottwald T, Schurr MO (2013) Performance of the OTSC System in the endoscopic closure of iatrogenic gastrointestinal perforations: a systematic review. Surg Endosc 27:2258–2274PubMedCrossRef
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Mennigen R, Colombo-Benkmann M, Senninger N, Laukoetter M (2013) Endoscopic closure of postoperative gastrointestinal leakages and fistulas with the over-the-scope clip (OTSC). J Gastrointest Surg 17:1058–1065PubMedCrossRef
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Mönkemüller K, Peter S, Toshniwal J et al (2013) Multipurpose use of the ‘bear claw’ (over-the-scope-clip system) to treat endoluminal gastrointestinal disorders. Dig Endosc 26:350–357PubMedCrossRef
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Weiland T, Fehlker M, Gottwald T, Schurr MO (2012) Performance of the OTSC system in the endoscopic closure of gastrointestinal fistulae–a meta-analysis. Minim Invasive Ther Allied Technol 21:249–258PubMedCrossRef
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Fähndrich M, Sandmann M, Heike M (2011) Removal of over the scope clips (OTSC) with an Nd:YAG laser. Z Gastroenterol 49:579–583PubMedCrossRef
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Mönkemüller K, Toshniwal J, Zabielski M (2012) Endoscopic removal of an over-the-scope-clip („bear claw“). Gastrointest Endosc 76:1077–1078PubMedCrossRef
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Neumann H, Diebel H, Mönkemüller K et al (2012) Description of a new, endoscopic technique to remove the over-the-scope-clip in an ex vivo porcine model (with video). Gastrointest Endosc 76:1009–1013PubMedCrossRef
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Arezzo A, Bullano A, Fischer H, Morino M (2013) The way to remove an over-the-scope-clip (with video). Gastrointest Endosc 77:974–975PubMedCrossRef
Metadata
Title
DC current pulses for OTSC clip fragmentation: technology and experimental study
Authors
Sebastian Schostek
C. N. Ho
M. Melbert
M. Krautwald
A. Caputo
G. Parisi
M. Wehrmann
T. Gottwald
M. O. Schurr
Publication date
01-08-2015
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 8/2015
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-014-3935-6

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