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Description
New compact design allows the use in small lumina or difficult to access lesions in the gastrointestinal tract
Use of the mini OTSC® System Set
The new compact design of the mini OTSC® System allows the use of the application technique of the proven OTSC® System for small lumen or difficult to access lesions in the gastrointestinal tract.
The mini OTSC®
The mini OTSC® System Set consists of an applicator cap with a mounted clip, thread, thread retriever and a hand wheel for clip release.
The mini OTSC® clip is delivered by means of an applicator cap mounted to the tip of endoscopes. By turning the hand wheel, the white application ring is pulled towards the distal end of the cap and the clip is released.
The mini OTSC® clip for flexible endoscopy is a superelastic Nitinol® device for compression and approximation of tissue in the digestive tract.
Based on its unique design the clip closes itself and firmly anchors the tissue to be compressed for hemorrhage or closure of a GI organ wall lesion. Due to its smart material properties, the mini OTSC® clip delivers constant force at the application site securing the therapeutic effect. The mini OTSC® clip is made of a biocompatible and MR conditional material and can remain in the body as a longterm implant.
Dimensions and specifications
Features and sizes of the applicator caps:
The mini OTSC® applicator cap is suitable for endoscopes with a diameter from 8.5 – 9.8 mm and has a cap depth of 3 mm.
Features of the clips:
The mini OTSC® Clip is a smaller version of the OTSC® Clip 11 and is available in one size with two different shapes of teeth (types a and t).
Application of the mini OTSC® System Set
Hemostasis with suction technique
In most GI bleeding situations, tissue can be mobilized and securely pulled inside the application cap by simply applying endoscopic suction. Once the target tissue is captured inside the cap, hemostasis is achieved by turning the handwheel to release the OTSC® clip around the captured tissue.
Target the lesion with the OTSC® System
Bring the OTSC® cap in contact with the tissue
Suction the target tissue into the cap
Apply the OTSC® clip by turning the hand wheel
Example 1*:
Hemostasis of arterial bleeding
*Source: Prof. Dr. Chiu, Prince of Wales Hospital, Hong Kong SAR, China
Example 2*:
Bleeding peptic ulcer in the gastric antrum (anticoagulated patient)
*Source: Dr. Thomas Kratt, Interventional Endoscopy, Klinik für Allgemeine, Viszeral- und Transplantationschirurgie, University Hospital Tuebingen, Germany
Hemostasis with anchor technique
In cases of fibrotic or hard tissue (e.g. callous ulcers) or tangential application, the OTSC® Anchor can be valuable in precisely aligning target tissue with the cap opening and keeping it fixed during clip release. It may not always be possible to manipulate fibrotic tissue fully inside the cap. However, it is sufficient to pull the tissue firmly to the rim of the cap with the OTSC® Anchor, then apply the clip. The clip “jumps” slightly forward upon release and grasps the tissue in front of the cap.
Position the OTSC® Anchor and fix the tissue
Align the OTSC® cap to the lesion by pulling the anchor and advancing the endoscope
Mobilize the tip of the OTSC® Anchor shaft into the cap; anchor spikes may remain external; release the OTSC® clip
After clip application, detach the OTSC® Anchor from the tissue
Fistula closure
Target fistula opening, position the OTSC® Anchor and fix tissue
Align OTSC® cap to the fistula opening by pulling the anchor and advancing endoscope
Mobilize tip of OTSC® Anchor shaft into cap; anchor spikes may remain external
Apply clip; release OTSC® Anchor from tissue
Example*:
Closure of persistent PEG-fistula using the OTSC® Anchor
*Source: Dr. Thomas Kratt, Interventional Endoscopy, Klinik für Allgemeine, Viszeral- und Transplantationschirurgie, University Hospital Tuebingen, Germany
Optimized fistula closure
Mucosal incision (circular; not too deep, because of perforation risk) around the fistula opening with the AqaNife (Ø ~ 15 mm)
Positioning of the clip in the incision line
Clip application and closure of the fistula
Example*:
Closure of a large esophago-bronchial fistula through mucosal incision prior to OTSC® placement
*Source: Meining A. et al. (2015) Erfolgreicher Verschluss einer großen ösophago-bronchialen Fistel durch mukosale Inzision vor OTSC-Klipp-Platzierung. Endoskopie heute. Doi: 10.1055/s-0035-1545049.
