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

Clinical procedure: Hemostasis

Targeting the lesion

Approximation of the application cap and the target tissue

Target tissue is sucked into the cap and OTSC® clip is released by turning the hand wheel

Clip is applied

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

Clinical procedure: closure of acute wall lesion

 

Targeting the lesion and approximation of the applicator cap and the target tissue.

Grasping the first edge of the lesion with one of the two jaw parts of the OTSC® Twin Grasper®

Grasping the first edge of the lesion with one of the two jaw parts of the OTSC® Twin Grasper®

Grasping the opposite edge with the second jaw part

Retraction of the perforation into the cap (OTSC® Twin Grasper® must be pulled back completely into the cap)

Clip release and removal of OTSC® Twin Grasper® from the tissue

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

 

Clinical procedure: Use of OTSC® Anchor as a guiding instrument

OTSC® Anchor positioning and tissue fixation; align the OTSC® cap to the lesion by pulling the Anchor and advancing the endoscope

Mobilize the tip of the OTSC® Anchor shaft into cap. Anchor spikes may remain external. Clip release

After clip application detach the OTSC® Anchor from the 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

Clinical procedure: 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.

 

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