With OTSC®neo, we have created an innovative clipping system for endoscopic hemostasis and the closure of acute and chronic wall lesions which represents a total performance evolution of the proven OTSC® System.

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Use of the OTSC®neo System Set

Das OTSC®neo System Set wird in der flexiblen Endoskopie im Gastrointestinaltrakt eingesetzt für:

  • Compression and tissue approximation
  • Hemostasis
  • Treatment of gastrointestinal organ wall lesions
  • Marking of lesions

The OTSC®neo System Set

The OTSC®neo System Set consists of:

  • Applicator cap with a mounted clip made from super elastic Nitinol®
  • Thread
  • Thread retriever
  • Hand wheel for clip release

 

Application

Due to its unique design, the clip closes after application and anchors itself in the tissue. This stops bleeding or closes lesions of an organ wall in the gastrointestinal tract. Due to its smart material properties, the clip delivers a constant force on the tissue securing the therapeutic effect. The clip is made of biocompatible and MR conditional material and can remain in the body as a long-term implant.

Dimensions and specifications

To make the OTSC®neo System optimally suitable for different types of endoscopes and procedures, the following variants are available:

Features and sizes of the applicator caps:

Features and sizes of the applicator caps:

  • 3 different sizes suitable for all common flexible endoscopes: diagnostic and therapeutic gastroscopes as well as colonoscopes (sizes 11, 12 and 14)
  • 2 different cap depths (3 and 6 mm) for capturing smaller or larger quantities of tissue

Features of the clips:

  • 3 different sizes adapted to the applicator caps (11, 12 and 14)
  • 3 different shapes of teeth suitable for different indications:
    • Type a: blunt teeth, primarily compression effect
    • Type b: teeth with small spikes, compression and anchoring effect
    • Type gc: Elongated teeth with spikes for gastric wall closure

The article numbers can be found in the table below or in our reference list.

Endoscope insertion
part diameter Ø
[mm]		 Max. outer
diameter Ø
[mm]		 Depth of cap
[mm]		 Clip type Thread length
[cm]		 Variant Ref.No.
11 8.5 – 11 16 3 a 165 11/3 a 100.03n
t 165 11/3 t 100.04n
6 a 165 11/6 a 100.09n
t 165 11/6 t 100.10n
12 10.5 – 12 17.4 3 a 165 12/3 a 100.05n
220 12/3 a 100.28n
t 165 12/3 t 100.06n
220 12/3 t 100.29n
6 a 165 12/6 a 100.11n
220 12/6 a 100.30n
t 165 12/6 t 100.12n
220 12/6 t 100.31n
gc 165 12/6 gc 100.27n
14 11.5 – 14 20.1 3 a 220 14/3 a 100.07n
t 220 14/3 t 100.08n
6 a 220 14/6 a 100.13n
t 220 14/6 t 100.14n

Application of the OTSC®neo System Set

In most GI bleeding situations, the tissue can be mobilized and securely pulled inside the application cap by applying endoscopic suction. Once the target tissue is captured inside the cap, the OTSC®neo clip is released around the captured tissue and applied at the bleeding site by turning the hand wheel. This way, hemostasis is achieved.

Targeting of the lesion (with or without the OTSC® application aid).
Placement of the OTSC®neo cap on the tissue.
Suction of the target tissue into the OTSC®neo cap.
Application and placement of the OTSC®neo 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

In case of fibrotic or hard tissue (e.g. callous ulcers) or tangential application, the OTSC® Anchor can be valuable in precisely aligning the 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.

The OTSC® Twin Grasper® application aid supports the controlled closure of lesions through its two jaw parts. Opposite perforation edges can be grasped and approximated with the jaw parts. Afterwards, the tissue can be mobilized inside the cap and the perforation be closed with the OTSC®neo Clip. Thus, closure is possible from serosa to serosa.

Grasping of the first perforation edge with one of the OTSC® Twin Grasper® jaw parts.
Grasping of the opposite perforation edge with second jaw part.
Retract of perforation into cap (OTSC® Twin Grasper® must be fully inside cap).
Clip application and release of the 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

OTSC®neo is also suitable for closing gastrointestinal fistulas (e.g. anorectal, rectovaginal fistulas). The OTSC® Anchor can be used as an application aid to facilitate mobilization of the fistula orifice into the cap. Freshening/debridement of the tissue at the fistula and in the fistula tract, e.g. with the Fistula Brush or APC, can improve healing after closure with the OTSC®neo clip.

Targeting of the fistula opening and application of the OTSC® Anchor in fistula opening.
Positioning of the cap and light pulling of the tissue.
Mobilization of the tip of the OTSC® Anchor shaft into cap; anchor spikes may remain external.
Clip application and release of the 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

The optimized fistula closure using a mucosal incision can show good treatment results in otherwise refractory fistulas. Preparing the tissue by making a circular incision in the mucosa prior to closure with the OTSC®neo Clip can lead to reduced tissue tension around the fistula opening and more effective tissue compression by the clip. The fistula tract should also be freshened up, e.g. with the Fistula Brush or APC, to improve healing.

Mucosal incision (circular; not too deep, because of perforation risk) around the fistula opening with the AqaNife® (Ø ~ 15 mm)
Targeting of the fistula opening and application of the OTSC® Anchor in fistula opening.
Positioning of the cap and light pulling of the tissue.
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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