Volume 3, Issue 1 | October 2015
Image | Endoscopy

Over-the-Scope Clip for Control of a Recurrent Diverticular Bleed

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Ihab Kassab, MD1, Roy Dressner, DO2, and Steven Gorcey, MD, AGAF3

1Department of Internal Medicine, Jersey Shore University Medical Center, Neptune, NJ
2Department of Surgery, Monmouth Medical Center, Long Branch, NJ
3Division of Gastroenterology, Monmouth Medical Center, Long Branch, NJ

ACG Case Rep J 2015;3(1):5-6. http://dx.doi.org/10.14309/crj.2015.81. Published: October 9, 2015.

Case Report

An 87-year-old man with a history of diverticular bleed and abdominal aortic stenting presented with 3 episodes of hematochezia. Colonoscopy identified multiple diverticula, including one that was actively bleeding in the sigmoid colon (Figure 1). Two resolution clips were placed in the bleeding diverticulum with hemostasis (Figure 2).

Kassab-Figure-1 Kassab-Figure-2

Figure 1. Endoscopic view of the bleeding diverticulum.

Figure 2. Placement of conventional clips with successful primary hemostasis.

Twelve hours later, the patient had recurrent hematochezia. The previously placed aortic stent prevented cannulation of the inferior mesenteric artery by interventional radiology, so a repeat partial colonoscopy was performed without preparation, revealing fresh blood surrounding the 2 previously placed clips. An upper endoscope (Olympus 190 HQ; Olympus, Center Valley, PA) was fitted with a 13.6-mm over-the-scope clip (OTSC®; Ovesco, Tübingen, Germany) that was deployed over the diverticulum and the previously placed clips (Figure 3). The bleeding stopped immediately. The patient did not require surgery and was discharged the next day; he was followed over period of 4 months after discharge and had no further bleeding.

Kassab-Figure-3

Figure 3. OTSC® deployed over the diverticulum and the two conventional clips.

Diverticular bleed is the most common reason for lower gastrointestinal bleeding, particularly in older patients. Colonoscopy is considered to be the first-line diagnostic and therapeutic approach, with endoscopic clips generally effective at achieving hemostasis. Rebleeding is common and presents a clinical challenge. In such cases, radiological embolization and surgery are the next interventions; however, they are not without complications.1 The OTSC is a new device designed for mechanical compression and tissue approximation that has been used for complicated GI bleeding, management of perforations and fistulae, full-thickness resection of tumors, and stent anchoring.2 In addition, OTSC has been shown to be an effective method of endoscopic hemostasis for major gastrointestinal bleeding.3 Complications have been reported, including tongue injury as a result of accidental clip deployment in the mouth.4 The use of the OTSC allowed us to achieve hemostasis in our patient without the need for surgery or embolization.

 


Disclosures

Author contributions: I. Kassab wrote the manuscript and reviewed the literature. R. Dressner and S. Gorcey edited and reviewed the manuscript. S. Gorcey is the article guarantor.

Financial disclosure: None to report.

Informed consent was obtained for this case report.

Correspondence: Ihab Kassab, Jersey Shore University Medical Center, Internal Medicine, 1945 Route 33, Neptune, NJ 07753 (kassab.ihab@gmail.com).

Received: April 3, 2015; Accepted: June 2, 2015


References

  1. Ghassemi KA, Jensen DM. Lower GI bleeding: Epidemiology and management. Curr Gastroenterol Rep. 2013;15(7):333. Article | PubMed
  2. Mönkemüller K, Peter S, Toshniwal J, et al. Multipurpose use of the ‘bear claw’ (over-the-scope-clip system) to treat endoluminal gastrointestinal disorders. Dig Endosc. 2014;26(3):350–357. Article | PubMed
  3. Chan SM, Chiu PW, Teoh AY, Lau JY. Use of the over-the-scope clip for treatment of refractory upper gastrointestinal bleeding: A case series. Endoscopy. 2014;46(5):428–431. Article | PubMed
  4. Mangiavillano B, Morandi E, Masci E. Accidental endoscopic piercing of the tongue with an Ovesco clip. Endoscopy. 2012;44(suppl 2):E221. Article | PubMed

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© 2015 Kassab et al. This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-nd/4.0.