Pediatric OTSC® application achieved 90 % clinical success in various indications

A study analyzing data of two referral pediatric endoscopy units identified 24 OTSC applications in 20 pediatric patients. Indications for OTSC therapy were mostly non-healing PEG fistula and acute non-variceal upper GI bleeding. Technical success was achieved in 95 % and clinical success in 90 % of patients. One serious adverse event was reported.

S. Sharma et al., Center for Pediatric Gastroenterology, Sheffield Children’s Hospital NHS Trust, Sheffield, UK, reported results of a database analysis on OTSC application in children in two regional/national referral pediatric endoscopy units in the United Kingdom and in the United States.

Case details were collected prospectively after approval of the use of the OTSC as a service evaluation project at center 1 and after an Internal Review Board approval at center 2 between 02/2018 and 02/2021. Patients were considered appropriate for OTSC therapy where conservative and established medical or surgical treatment had either failed or was not desirable.
The databases incorporated data on demographics, presentation, anthropometry, comorbidities, efficacy, adverse events, and post-procedure follow-up, as well as identification of resolution or recurrence.

Overall 20 patients were identified in whom OTSC deployment had been performed. The mean age of patients was 12 years (range 5 – 17), the mean weight was 44.42 kg (range 18.2 – 70.3 kg), the female: male ratio was 11:9. Indications for OTSC application were non-healing PEG site fistula (n=7), acute non-variceal bleeding from gastric ulcers (n=5) acute non-variceal bleeding from duodenal ulcers (n=3), non-healing bleeding anastomotic ulcer (n=3), esophageal mucocutaneous fistula (n=1) and gastric perforation (n=1). Technical success (successful deployment of the OTSC device at the target site) was achieved in all but one case (95 %), and clinical success (successful resolution of the luminal problem for which the OTSC was indicated) was achieved in 18 cases (90 %). Technical and clinical success rates were 100 % for all indications except PEG site fistulae, in which they were 85 % (6/7) and 71 % (5/7), respectively.
One serious adverse event was reported: during attempted esophageal intubation an esophageal perforation occurred. The patients was managed conservatively and discharged home after 7 days on PEG feeds.

The authors concluded that OTSC management appears to be effective in children (minimum age 5 years and minimum weight 18 kg) for different indications including anastomotic ulcer, closure of leaking PEG site, gastric perforation, and bleeding peptic ulcers. The endoscopist should be experienced and have absolved specific OTSC training. The type and size of the OTSC device should be carefully considered, along with any comorbidities of the patient that may preclude success and/or lead to potential adverse events such as esophageal perforation.

Applicability, efficacy, and safety of over-the-scope clips in children
Sharma S, Barakat M, Urs A, Campbelt D, Rao P, Schluckebier D, Gugig R, Thomson M
Gastrointest Endosc 2022; 95:489-99.
DOI: 10.1016/j.gie.2021.10.011