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
Fig. 1 The over-the-scope (OTS) clip located at the anterior wall of the rectum.
Fig. 2 A hydrostatic balloon was inserted within the loops of the OTS clip.
Fig. 3 Dilation of the balloon.
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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E-Videos is an open access online section of the journal Endoscopy, reporting on interesting cases and new techniques in gastroenterological endoscopy.
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