Video case report: OTSC hemostasis in patients with refractory bleeding due to chronic peptic ulcer

Xiao X and Lau JY, Department of Surgery, Chinese University of Hong Kong, Hong Kong, published an article on VideoGIE, the official video journal of the American Society of Gastrointestinal Endoscopy, showing OTSC treatment in two patients with refractory peptic ulcer bleeding.

The first patient was an 89-year-old woman admitted with fresh hematemesis and a haemoglobin of 4.8g/dl. Endoscopy revealed bleeding from a 2-cm chronic bulbar ulcer. She was treated by angiographic embolization to her right gastroduodenal artery (GDA). Three days later, she again experienced massive bleeding. A pulsatile vessel at the ulcer base was discovered and treatment with an OTSC clip induced. The cap was adjusted to encompass the vessel, and a trip string was pulled to deploy the OTSC. The patient was discharged 4 days later without further bleeding.

Patient two was a 76 year old man presenting with fresh melena and a haemoglobin of 7.5 g/dl. He reported on a history of recurrent bleeding from a chronic gastric ulcer. Additionally, he had previously been on warfarin therapy for the treatment of deep vein thrombosis complicated by pulmonary embolism. Endoscopy revealed bleeding from a chronic ulcer at the ankle incisura of the stomach. The first attempt to stop the bleeding with heaterprobe and hemoclips failed. Then an OTSC anchor device was used to target the ulcer base and deploy an OTSC clip without suction. Complete hemostasis was achieved and the patient had an uneventful recovery.

The authors concluded that OTSC is useful in the treatment of chronic peptic ulcerations with refractory bleeding. The anchor device was rated a helpful tool, which allows accurate targeting of the bleeding artery.

Over-the-scope clip treatment of refractory peptic ulcer bleeding
Xiao X, Lau JY (2016)
Gastrointest Endosc. 2016 Feb;83(2):458-9. doi: 10.1016/j.gie.2015.05.040.