C A S E STUDY - Ovesco Endoscopy AG

Ovesco Endoscopy USA Inc. 455 Los Gatos Blvd., Suite 101, Los Gatos, CA 95032 408 884 8976 www.ovesco.com
OTSC® System Over-The-Scope-Clipping system for flexible endoscopy
C ASE STUDY
Hemchand Ramberan, MD
Clinical Assistant Professor of Medicine
Interventional and Therapeutic Gastrointestinal Endoscopy
University of Tennessee College of Medicine, Chattanooga
Academic Gastroenterology
Erlanger Hospital Chattanooga, TN
Severe life threatening Upper GI bleed treated successfully with Ovesco OTSC®
after failed initial endoscopic and angio-embolization treatment.
PATIENT PROFILE
A 40 year old male with chronic non steroidal anti-inflammatory (NSAID’s) use for back pain, presented with
features of a hemodynamically significant upper GI bleed (hematochezia, hematemesis, hypotension
(90/40 mmHg), tachycardia 146 beats/min, prerenal azotemia BUN 48, Cr 1.1 and severe anemia, Hgb 4.6
g/dL.
ENDOSCOPIC INTERVENTION
Fig. 1 Actively
Bleeding Antral Ulcer
Patient was resuscitated including transfusion of 6 units packed red blood cells and had an urgent EGD by
the gastroenterologist on call. Noted large volume fresh bright red blood and clots in stomach. Active
bleeding noted from a gastric antral ulcer with arterial spurting and visible vessel (Fig. 1). Attempts at
endoscopic treatment with epinephrine injection and multiple hemoclips placement could not control the
bleeding.
Patient went to interventional radiology, and had selective angiography of the celiac, hepatic and gastroduodenal
arteries. No bleeding (contrast extravasations) noted but described vasospastic

Ovesco Endoscopy USA Inc. 455 Los Gatos Blvd., Suite 101, Los Gatos, CA 95032 408 884 8976 www.ovesco.com
C ASE STUDY
gastroduodenal artery. Emperic embolization of GDA
performed and was continued on proton pump inhibitor
infusion. Thirty-six hours later, patient has severe re-bleeding
with frank large volume hematemesis, hypotension, tachycardia,
pallor, diaphoresis and near syncope. Hgb 6.0 g/dL Volume
resuscitated and transfused 6 units of packed red blood cells.
Repeat emergent EGD performed. Noted with fresh bright red
blood and clots in stomach. Active bleeding noted in antrum
with overlying adherent clot. None of the clips previously
placed are evident.
Clot guillotined and removed with a Roth Net, exposing the
actively spurting vessel at the base of a large ulcer. Endoscopic
treatment was effected with submucosal 1:10,000 epinephrine
to achieve temporary hemostasis and better visualization
(Fig. 2). The Ovesco OTSC® system was used to clip the artery
and surrounding fibrotic edematous base of the ulcer with
success (Fig. 3).
Fig. 2 Temporary hemostasis blanching and
tamponade with epinephrine injection.
PATIENT OUTCOME
The patient was discharged 72 hours later without bleeding
and stable Hgb 9.8 g/dL. Subsequent follow-up at 2 weeks
showed no delayed recurrent bleeding.
Fig. 3 OTSC clip on vessel and surrounding base
DISCUSSION
Complex ulcer with fibrotic edematous base. Low success with the standard hemoclips in this case.
Failed embolization, extended stay in the ICU. If this approach was not utilized, endoscopic therapy
would not have been definitive; then the other option was repeat angiography and/or surgery. This
increases the cost of care for a patient with GI bleeding when the insurers allocate a fixed amount irrespective
of how much is done (so called DRG’s). Although the individual cost of an OTSC® clip is higher than
traditional endoclips, this system can actually be more cost effective, in that only one clip is required
versus 3-6 endoclips per case.
Ovesco Endoscopy USA Inc.
408 884 8976
www.ovesco.com
otsc®_erlanger_hospital_case_study_english/rev01_2013-06-11