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• W2155655117 abstract "The “bear claw” or over-the-scope-clip (OTSC) system (Ovesco Endoscopy, Tübingen, Germany) is an innovative clipping device made of superelastic biocompatible Nitinol.1von Renteln D. Schmidt A. Vassiliou M.C. et al.Endoscopic closure of large colonic perforations using an over-the-scope clip: a randomized controlled porcine study.Endoscopy. 2009; 41: 481-486Crossref PubMed Scopus (67) Google Scholar, 2von Renteln D. Rösch T. Kratt T. et al.Endoscopic full-thickness resection of submucosal gastric tumors.Dig Dis Sci. 2012; 57: 1298-1303Crossref PubMed Scopus (42) Google Scholar, 3von Renteln D. Denzer U.W. Schachschal G. et al.Endoscopic closure of GI fistulae by using an over-the-scope clip (with videos).Gastrointest Endosc. 2010; 72: 1289-1296Abstract Full Text Full Text PDF PubMed Scopus (95) Google Scholar This clipping device has been proved useful to close wall defects of the luminal GI tract such as perforations, anastomotic leaks, fistulas, and large defects occurring after endoscopic submucosal dissection or endoscopic full-thickness resection.1von Renteln D. Schmidt A. Vassiliou M.C. et al.Endoscopic closure of large colonic perforations using an over-the-scope clip: a randomized controlled porcine study.Endoscopy. 2009; 41: 481-486Crossref PubMed Scopus (67) Google Scholar Once the OTSC is applied, it remains attached to the mucosa. It is not known whether the OTSC sloughs off spontaneously over time. However, it is anticipated that on occasion a placed OTSC will need to be removed. Removal may need to be accomplished acutely because of misplacement or after the OTSC has fulfilled its function. Herein we present the endoscopic removal of an OTSC that had been used to anchor an esophageal stent. A 77-year-old man with multiple medical problems had undergone a distal esophagectomy with gastric pull-up for an adenocarcinoma of the gastric cardia. An anastomotic leak had been treated with an OTSC 10 days prior. However, the leak persisted, and malposition of the OTSC was suspected. EGD revealed the OTSC just proximal to the anastomotic opening (Fig. 1). To place another clip, a decision to remove this OTSC was taken. The base of the clip was injected with about 6 to 7 mL of saline solution. This raised the clip partially from the mucosa. Then a snare was placed around the clip. The snare was closed slowly and pulled proximally (Fig. 2). This resulted in dislodgement of the clip. The clip was then grasped with the snare and removed (Figure 3, Figure 4). Careful attention was paid to grasp the two ends of the clip and to pull it closely to the tip of the scope. In this way the scope served as a “pathfinder” for the OTSC, “opening the way” for the large diameter clip. No damage occurred while the clip was pulled through the esophagus and its physiologic narrowings, including the upper esophageal sphincter. A new clip was used to close the anastomotic leak (Fig. 5).Figure 2View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 3View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 4View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 5View Large Image Figure ViewerDownload Hi-res image Download (PPT) This case is interesting because it demonstrates that removal of the OTSC is feasible. First, local dislodgement was possible with the use of submucosal saline solution injection and a cold “polypectomy” technique. A similar snare technique has been previously used to remove 24-hour pH Bravo capsules tightly adherent to the esophageal mucosa.4de Hoyos A. Esparza E.A. Loredo M.L. Cold and hot snare endoscopic techniques for removal of the Bravo pH monitoring capsule.Digestion. 2009; 79: 14-16Crossref PubMed Scopus (6) Google Scholar In another report, Bravo capsules were removed with the use of endoscopic scissors.5Agrawal D. Akerman P.A. Rich H. Removal of a Bravo 24-hour pH capsule with endoscopic scissors.Gastrointest Endosc. 2009; 70: 385-386Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar This is another technique that may be used to remove the “bear claw.” In addition, we show that extraction of this relatively large foreign body can be accomplished without damage to the esophageal wall." @default.
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• W2155655117 date "2012-11-01" @default.
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• W2155655117 title "Endoscopic removal of an over-the-scope-clip (“bear claw”)" @default.
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• W2155655117 doi "https://doi.org/10.1016/j.gie.2012.06.009" @default.
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