OTSC® placement in the colon in routine endoscopy: administrative data from large health insurance company shows high safety and efficacy.

Colonic OTSC placement was mostly performed in patients undergoing polypectomy (62.4 %), but also for closure of iatrogenic perforations (15.8 %), colonic bleeding (10.1 %) and not further specified other underlying diseases (11.7 %). Surgical interventions within 10 days after OTSC placement were performed in 1.6 % of patients after polypectomy, 13.8 % of patients after iatrogenic perforation, and 7.8 % of patients with colonic bleeding. Only one case of surgical intervention during further follow-up could potentially be traced back to an endoscopic procedure complication.

D. Horenkamp-Sonntag et al., Techniker Health Insurance (Techniker Krankenkasse), Hamburg, Germany, performed a study investigating OTSC use in the colon in routine endoscopy using their own administrative data as a large statuatory German health insurer. As application of OTSC during colonoscopy generates a specific code in the German diagnosis-related group (DRG) reimbursement system, respective patient data can be identified and analysed. The health insurance database comprises approximately 10 million insured patients, it contains all procedures performed in hospitals as well as in outpatient care. The results of the study thereby can be considered as representing German routine clinical practice in terms of indications, effectiveness, and complications of endoscopy of the cases treated with OTSC in the colon.

Overall 505 patients undergoing colonoscopy with simultaneous OTSC application, but not undergoing upper GI endoscopy on the same day, were identified. According to indications for OTSC clipping, the cohort was divided into 4 groups: patients with iatrogenic perforations (n = 80; Group A), patients undergoing polypectomy (n = 315; Group B), patients with colonic bleeding (n = 51; Group C), and patients with various underlying diseases (n = 59; Group D).

13.8 % of patients of group A (n = 11) underwent an operative procedure during the short follow-up period of 10 days after clipping, in 9 of these cases surgery was carried out within 24 hours after clipping, in 8 patients laparoscopic suturing of the defect was the only operative procedure, in 3 patients surgery included colonic resection. In Group B early colonic surgery within 10 days after clipping was necessary in 5 patients (1.6 %). Surgical interventions included resection in 3 cases (all of which had colorectal cancer), laparoscopic suturing in one case, and diagnostic laparoscopy without any further procedure in one patient. In Group C, 7.8 % of patients (n = 4) had to undergo surgical resections (persistent bleeding n = 1, colorectal cancer n = 2), while in 6 patients early repeat colonoscopy was performed for recurrent bleeding. During further follow-up (days 11 – 30), 17 patients underwent resection for colonic neoplasms (n = 12) or persistent or recurrent bleeding (n = 4). Only in one patient (Group A), a plausible cause for surgery could not be identified and might represent delayed insufficiency of the endoscopic closure site.

The authors concluded that OTSC placement in the colon is safe and effective in clinical routine.

Use of over-the-scope clips in the colon in clinical practice: results from a German administrative database
Horenkamp-Sonntag D, Liebentraut J, Engel S, Skupnik C, Albers D, Schumacher B, Koop H.
Endoscopy 2020; 52: 1103-1110. DOI 10.1055/a-1206-0778