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DOI: 10.1055/a-2651-0084
Removal of an over-the-scope clip using balloon dilation
Authors
Over-the-scope (OTS) clips have revolutionized the management of gastrointestinal perforations, ulcers, and fistulas [1]. In some cases, removing these clips is necessary, but due to their strong grip, typical forceps often fail. There is a dedicated device for removal, but it can be difficult to obtain. Various alternative techniques have been described, such as plasma argon coagulation, endoscopic submucosal dissection (ESD) or yttrium aluminum garnet crystal (YAG) laser [2]. Here we describe the case of an OTS clip removed using hydrostatic balloon dilation.
This case involves a 71-year-old patient who underwent a cystectomy and prostatectomy and subsequently developed a fistula between the neobladder and the rectum. Initially, this fistula was treated by ESD followed by the placement of an OTS clip. Due to the persistence of a fistulous tract, it was decided to remove the OTS clip with balloon dilation as a new treatment ([Video 1]). The macro-clip was located at the anterior wall of the rectum ([Fig. 1]). A 15-mm diameter hydrostatic balloon was used, which was inserted within the loops of the OTS clip using a guidewire ([Fig. 2]). Once the balloon was properly positioned, it was dilated within the macro-clip up to 15 millimeters ([Fig. 3]). Dilation of the macro-clip reopened its jaws, which subsequently closed on and pierced the ballon. The dilation balloon was then removed, with the OTS clip attached to the ballon. Endoscopic control showed no local complications. The successful removal of the macro-clip allowed a new ESD treatment of the fistulous tract and the successful placement of a new macro-clip, efficiently closing the fistula.
Removal of an over-the-scope clip using balloon dilation.Video 1
This case illustrates the use of a standard hydrostatic dilation balloon for removing a macro-clip, which constitutes an interesting alternative to other previously described methods.
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Publikationsverlauf
Artikel online veröffentlicht:
04. September 2025
© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
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References
- 1 Schmidt A, Gölder S, Goetz M. et al. Over-the-scope clips are more effective than standard endoscopic therapy for patients with recurrent bleeding of peptic ulcers. Gastroenterology 2018; 155: 674-686.e6
- 2 Ou YH, Kong WF, Li LF. et al. Methods for endoscopic removal of over-the-scope clip: A systematic review. Can J Gastroenterol Hepatol 2020; 2020: 5716981