Primary hemostasis using miniOTSC for rectal bleeding near the pectinate line – an observational study

Aims Lower gastrointestinal bleeding in the rectum is rare and difficult to treat. Bleeding close to the pectinate line is a particular challenge. Conventional permanent hemostasis procedures, e.g. with haemoclips, are often a major challenge due to the exposed location. An alternative procedure is the application of a mini-OverTheScopeClip (OTSC) (Ovesco, Tübingen, Germany) for mechanical hemostasis. In our observational study, patients with rectal bleeding near the dentate line received a mini-OTSC for hemostasis.

Methods Included were all patients with evidence of acute lower gastrointestinal bleeding from a bleeding vessel (with or without ulcer) in the area of the pectinate line. Transfusion of red blood packs and hemoglobin levels before and after the intervention were recorded.

Results From April 2021 to November 2023, a total of 6 patients (mean age 72.2 (+ /-13.6), 4 men) with a Charlson Co-Mobidity Index of 8.6 (+ /- 2.3) and lower gastrointestinal bleeding from a bleeding vessel (Forrest Ia or Ib) in the area of the pectinate line were included in the study. In all cases, a Mini-OTSC (Ovesco, Tübingen, Germany) was applied to the source of bleeding for primary hemostasis. In all cases, the procedure was technically successful (6/6, 100%) with no evidence of peri-interventional complications. The mean hemoglobin level of the patients before the intervention was 7.7 g/dl (+ /- 0.43 g/dl), in three patients the transfusion of erythrocyte concentrates (one patient received 7 ECs, two others received 2 ECs each) took place before the intervention. During the follow-up period of 3.5 days (IQR 19 days, three patients 2 days, one patient 5 days, one patient 21 days, one patient 81 days), there were no clinical signs of post-interventional bleeding and the hemoglobin level was stable at 9.0 g/dl (+ /- 1.0 g/dl). No further endoscopic intervention was required in any of the cases described

Conclusions The application of a miniOTSC is a safe and effective method for primary hemostasis for rectal gastrointestinal bleeding near the pectinate line. It can be assumed that this method could reduce repeat interventions due to recurrent bleeding compared to conventional methods. This should be evaluated in a prospective study.

Publication History

Article published online:
27 March 2025