Outcomes of gastrointestinal defect closure with an over-the-scope clip system in a multicenter experience: An analysis of a successful suction method

Figure 1 Key factor for the success of over-the-scope clips: schema of three suction methods into the application cap of the target lesion. A: Simple suction, similar to endoscopic variceal band ligation (simple suction method); B: Assist of grasping forceps: Twin Grasper device (Twin Grasper method); C: Assist of tissue anchoring device (Anchor assist).

Figure 2 Flow diagram of patient enrollment and outcomes. ¹Clinical outcomes of two cases that used the Anchor: one case with an incomplete closure of an esophageal-gastric anastomotic leakage, and another case with clinical success of gastric fistula after percutaneous endoscopic gastrostomy. SS: Simple suction; TG: Twin Grasper.

Figure 3 Representative clinical success case in the simple suction-group that exhibited refractory bleeding with a defect size of ≤ 10 mm and an immediate duration since onset. A: A spurting, bleeding ulcer that was located in a rectal anastomotic site; B: Complete hemostasis via over-the-scope clip closure using the simple suction method after the failure of conventional endoscopic intervention.

Figure 4 Representative clinical success case in the Twin Grasper-group of a leak with a defect size of ≤ 10 mm and an immediate duration since onset. A: An iatrogenic perforation site approximately 10 mm in size, located in the 2^nd portion of the duodenum during endoscopic retrograde cholangiopancreatography; B: Application of the Twin Grasper device; C: Complete defect closure three months after over-the-scope clip deployment.

Figure 5 Representative case with an over-the-scope clips complication. A: A delayed perforation with a 50-mm defect size after gastric endoscopic submucosal dissection; B: The misplacement of the over-the-scope clips to the exposed muscularis propria induced additional tears (black arrows); C: The defect could not be closed by the Twin Grasper due to a narrow lumen located in the prepylorus.

Figure 6 Clinically unsuccessful case in the simple suction-group of a fistula with a defect size of ≤ 10 mm and a chronic duration. A: An 8-mm gastric fistula after interventional endoscopic ultrasound for a pseudo-pancreatic cyst; B: Complete closure with one over-the-scope clip (OTSC) using the simple suction method; C: A delayed leakage (black arrows) that occurred 2 wk after OTSC placement; D: X-ray contrast photo via a percutaneous drainage tube that revealed the delayed leakage.