Case series of 11 OTSC applications in 10 pediatric patients shows 100 % technical success with immediate hemostasis and no complications.
Tran P et al., UT Southwestern Medical Center, Children’s Health – Children’s Medical Center Dallas, TX, USA, published the center’s experience utilizing OTSCs for nonvariceal gastrointestinal bleeding in pediatric patients. Overall 10 patients (median age 14.7 years, range 3.9 – 16.8 years, median weight 39 kg, range 17.4 – 85.8 kg) underwent 11 endoscopic procedures utilizing the OTSC System for hemostasis. Upper GI bleeding due to stomach or duodenal ulcer was seen in 4 patients, 2 of these had ulcer disease of the stomach and duodenum, respectively, secondary to nonsteroidal anti-inflammatory drug use. 1 patient had peptic ulcer disease of unknown etiology and 1 had duodenal ulcers secondary to active Helicobacter pylori infection. Upper intestinal bleeding was found in 2 other patients, 1 with postpolypectomy bleeding in the stomach and 1 with biliary sphincterotomy. Lower intestinal bleeding was seen in the remaining 4 patients. 1 patient had an ulcer located in the sigmoid colon presumed to be secondary to intestinal ischemia, 1 had postpolypectomy bleeding in the sigmoid colon, and 2 patients had anastomotic ulcers, 1 at an ileoileal and 1 at an ileocolonic anastomosis. 4 patients (40 %) had OTSC placed as first-line intervention.
Placement of the OTSC was technically successful in all patients resulting in immediate hemostasis. No complications occurred. The two patients with anastomotic ulcers have continued to have clinical bleeding resulting in chronic anemia. One of these patients continues to require monthly iron infusions and the other remains transfusion dependent. The remaining 8 patients have had no evidence of recurrent bleeding at follow-up (median follow-up time 32.9 months, range 21.2 – 39.4 months).
The authors concluded that the OTSC System is a reliable and effective tool for active GI bleeding or high-risk lesions and should be considered for high risk or urgent/emergent cases of bleeding in children.
Over the Scope Clips for Treatment of Acute Nonvariceal Gastrointestinal Bleeding in Children Are Safe and Effective.
Tran P, Carroll J, Barth BA, Channabasappa N, Troendle DM.
JPGN 2018;67: 458-463.