Endoscopy 2019; 51(04): S141-S142
DOI: 10.1055/s-0039-1681586
ESGE Days 2019 ePoster podium presentations
Friday, April 5, 2019 13:00 – 13:30: GI bleeding 2 ePoster Podium 6
Georg Thieme Verlag KG Stuttgart · New York

THE USE OF OVER-THE-SCOPE CLIP IN THE MANAGEMENT OF ACUTE ESOPHAGEAL VARICEAL BLEEDING

C Mangas-Sanjuan
1   Endoscopy Unit, Hospital General Universitario de Alicante, Alicante, Spain
2   Instituto de Investigación Sanitaria y Biomédica de Alicante, ISABIAL, Alicante, Spain
,
M Bozhychko
1   Endoscopy Unit, Hospital General Universitario de Alicante, Alicante, Spain
2   Instituto de Investigación Sanitaria y Biomédica de Alicante, ISABIAL, Alicante, Spain
,
B Martínez
3   Endoscopy Unit, Hospital Universitario del Vinalopó, Elche, Alicante, Spain
,
L Compañy
1   Endoscopy Unit, Hospital General Universitario de Alicante, Alicante, Spain
2   Instituto de Investigación Sanitaria y Biomédica de Alicante, ISABIAL, Alicante, Spain
,
FA Ruiz
1   Endoscopy Unit, Hospital General Universitario de Alicante, Alicante, Spain
2   Instituto de Investigación Sanitaria y Biomédica de Alicante, ISABIAL, Alicante, Spain
,
J Martínez Sempere
1   Endoscopy Unit, Hospital General Universitario de Alicante, Alicante, Spain
2   Instituto de Investigación Sanitaria y Biomédica de Alicante, ISABIAL, Alicante, Spain
,
JA Casellas
1   Endoscopy Unit, Hospital General Universitario de Alicante, Alicante, Spain
2   Instituto de Investigación Sanitaria y Biomédica de Alicante, ISABIAL, Alicante, Spain
,
J Ramón Aparicio
1   Endoscopy Unit, Hospital General Universitario de Alicante, Alicante, Spain
2   Instituto de Investigación Sanitaria y Biomédica de Alicante, ISABIAL, Alicante, Spain
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

Also available at
 

Aim:

Esophageal bleeding control associated to portal hypertension (PHT) might be difficult using endoscopy band ligation (EBL) due to either collapse of the bleeding varix or scarring the mucosa due to fibrosis secondary to prior banding. The over-the-scope clip (OTSCs; Ovesco, Tübingen, Germany) has been reported to control non-variceal bleeding, but thereis scarce data about the use related to variceal bleeding (VB). So our aim is to describe our experience in terms of efficacy and safety with this novel method.

Methods:

We report a case series study of consecutive adult patients with active VB treated with OTSC after EBL failure between October2017 to September2018 at a two tertiary care centers in our region. Efficacy of bleeding control is the absence of bleeding immediately after using OTSC until 7-days after; safety is the absence of complications associated with OTSC placement during 30-day follow-up period.

Results:

Total 5 patients are included (3men/2women), and the mean age is 57 years (50 – 64 years). 4 patients have PHT due to liver cirrhosis and one has nodular regenerative hyperplasia because of Osler-Weber-Rendu disease. 80% have clinically significant PHT (HVPG mean 15 mmHg, 13 – 16 mmHg) and 100% of patients had prior EBL (1 – 3 sessions). In 4 cases EBL was not possible due to collapse of the varix and the other was due to scarring the mucosa. We use OTSC type “t” (pointed teeth) 12 mm using a diagnostic videogastroscope (GIF-H290; Olympus Medical Systems, Tokyo, Japan) in all cases. Adequate bleeding control was achieved in 100% of patients, and no re-bleeding occurred. There were no complications during 30-day follow-up and only one patient developed dysphagia after 4 months of placement.

Conclusion:

When there is an esophageal variceal bleeding refractory to EBL, the use of OTSC can be an endoscopic effective and safety alternative in the pursuit of bleeding control.