OTSC® System Set

Innovative clipping system intended for endoscopic treatment of gastrointestinal hemorrhage and closure of acute and chronic wall lesions To OTSC® System Set
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Description

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Use of the OTSC® System Set

The OTSC® System Set is an instrument for flexible endoscopy. It can be used for compression of tissue in the gastrointestinal (GI) tract, for hemostasis or for treating gastrointestinal organ wall lesions, and for marking of lesions. The clip OTSC® gc is specially designed for the treatment of perforations and lesions of the stomach.

The OTSC® System Set

The OTSC® System Set consists of an applicator cap with a mounted OTSC® clip, thread, thread retriever and a hand wheel for clip release.

The OTSC® clip is delivered by means of an applicator cap mounted to the tip of gastroscopes or colonoscopes. The clip is released by tightening the thread with the hand wheel.

The 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, OTSC® clip delivers constant force at the implantation site securing the therapeutic effect. The OTSC® clip is made of a biocompatible and MR conditional material and can remain in the body as a longterm implant.

Dimensions and specifications

The OTSC® system is very flexible and will thus allow for multiple indications and most of the conventional equipment in endoscopy. There are various clips and caps classified as follows:

Features and sizes of the applicator caps:

  • Three different sizes of caps suitable for almost all commercially available endoscopes (sizes 11, 12, 14)
  • Two different depths of caps for grasping more or less tissue during approximation (3 and 6 mm)

Features of the clips:

  • Three different sizes adapted to the cap sizes (sizes 11, 12, 14)
  • Three different shapes of teeth suitable for different indications and tissues (types a, t, gc)

Application of the 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.

Blutstillung mit dem OTSC System und Saugung Schritt 1

Target the lesion with the OTSC® System

Blutstillung mit dem OTSC System und Saugung Schritt 2

Bring the OTSC® cap in contact with the tissue

Blutstillung mit dem OTSC System und Saugung Schritt 3

Suction the target tissue into the cap

Blutstillung mit dem OTSC System und Saugung Schritt 4

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.

Blutstillung mit dem OTSC System und Ankertechnik Schritt 1

Position the OTSC® Anchor and fix the tissue

Blutstillung mit dem OTSC System und Ankertechnik Schritt 2

Align the OTSC® cap to the lesion by pulling the anchor and advancing the endoscope

Blutstillung mit dem OTSC System und Ankertechnik Schritt 3

Mobilize the tip of the OTSC® Anchor shaft into the cap; anchor spikes may remain external; release the OTSC® clip

Blutstillung mit dem OTSC System und Ankertechnik Schritt 4

After clip application, detach the OTSC® Anchor from the tissue

Perforation closure

Perforationsverschluss mit dem OTSC TwinGrasper Schritt 1

Grasp first perforation edge with one of the two OTSC® Twin Grasper® jaw parts

Perforationsverschluss mit dem OTSC TwinGrasper Schritt 2

Grasp opposite perforation edge with second jaw part

Perforationsverschluss mit dem OTSC TwinGrasper Schritt 3

Retract perforation into cap (OTSC® Twin Grasper® must be fully inside cap)

Perforationsverschluss mit dem OTSC TwinGrasper Schritt 4

Apply clip and release OTSC® Twin Grasper®

Example:*

Perforation closure in the colon with OTSC® Twin Grasper®

*Source: Dr. Thomas Kratt, Interventional Endoscopy, Klinik für Allgemeine, Viszeral- und Transplantationschirurgie, University Hospital Tuebingen, Germany

Fistula closure

Fistelverschluss mit dem OTSC Schritt 1

Target fistula opening, position the OTSC® Anchor and fix tissue

Fistelverschluss mit dem OTSC Schritt 2

Align OTSC® cap to the fistula opening by pulling the anchor and advancing endoscope

Fistelverschluss mit dem OTSC Schritt 3

Mobilize tip of OTSC® Anchor shaft into cap; anchor spikes may remain external

Fistelverschluss mit dem OTSC Schritt 4

Apply clip; release OTSC® Anchor from tissue

Example*:

Closure of persistent PEG-fistula using the OTSC® Anchor

PEG-Fistel_mit-Rahmen

*Source: Dr. Thomas Kratt, Interventional Endoscopy, Klinik für Allgemeine, Viszeral- und Transplantationschirurgie, University Hospital Tuebingen, Germany

Optimized fistula closure

Optimierter Fistelverschluss mit dem OTSC System Schritt 1

Mucosal incision (circular; not too deep, because of perforation risk) around the fistula opening with the AqaNife (Ø ~ 15 mm)

Optimierter Fistelverschluss mit dem OTSC System Schritt 2

Positioning of the clip in the incision line

Optimierter Fistelverschluss mit dem OTSC System Schritt 3

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.

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