OVESCO REMOVE SYSTEM FOR EASY REMOVAL OF OVER-THE-SCOPE CLIPS - A PRACTICAL CASE

Sistema OVESCO remOVE para a remoção de OTSC - um caso prático.

We report a case of a 72-year-old man with a signet-ring gastric antrum adenocarcinoma that underwent total gastrectomy with Y-de-Roux procedure. The surgery was complicated by a severe dehiscence of the esophagojejunal anastomosis with perianastomotic abscess a week later. Endoscopic treatment was not considered feasible at the time. The patient underwent surgical drainage of the perianastomotic abscess, was started on broad-spectrum antibiotics and a jejunostomy was performed for feeding. Clinical evolution was favorable and endoscopic reevaluation after two months revealed an improvement of the anastomotic dehiscence, with only a 10 mm orifice remaining (Figure 1). In this regard, it was decided to place a fully covered self-expandable metallic stent, anchoring its proximal end with an over-the-scope clip (OTSC). Both stent and OTSC positions were confirmed by fluoroscopy and the patient was discharged asymptomatic 2 weeks after the procedure.

FIGURE 1
After 2 months of conservative management, upper gastrointestinal endoscopy revealed an improvement of the anastomotic dehiscence, with only a 10 mm orifice.

Five weeks after the procedure, the patient presented to the emergency department with abdominal pain and abdominal computed tomography scan revealed distal migration of the stent. The upper gastrointestinal endoscopy unveiled an intact but substenotic esophagojejunal anastomosis (Figure 2) and the migrated stent was visualized in a jejunal loop. However, the extraction was unsuccessful due to the inability to pass the OTSC through the substenotic anastomosis. Therefore, the OTSC clip cutter remOVE system^® (Ovesco Endoscopy AG, Tübingen, Germany) was used to split the OTSC in two fragments (E-VIDEO), thus allowing the removal of the stent without complications (Figure 3). The patient was discharged asymptomatic two days after the procedure.

FIGURE 2
Five weeks after endoscopic placement of a fully covered self-expandable metallic stent, upper gastrointestinal endoscopy unveiled an intact but substenotic esophagojejunal anastomosis.

FIGURE 3
Using the over-the-scope clip clip cutter remOVE system, the over-the-scope clip stentfix was split in two fragments, allowing the removal of the stent.

The OTSC is an endoscopic device used for several purposes, including prevention of stent migration¹. Endoscopic methods for its removal have different success rates and associated adverse events². The remOVE system is effective and easy to use, allowing safe removal of OTSC³.

REFERENCES

• ¹
  Mudumbi S, Velazquez-Aviña J, Neumann H, Kyanam Kabir Baig KR, Mönkemüller K. Anchoring of self-expanding metal stents using the over-the-scope clip, and a technique for subsequent removal. Endoscopy. 2014;46:1106-9.
• ²
  Ou YH, Kong WF, Li LF, Chen PS, Deng SH, He FJ, et al. Methods for Endoscopic Removal of Over-the-Scope Clip: A Systematic Review. Can J Gastroenterol Hepatol. 2020;2020:1-10.
• ³
  Bauder M, Meier B, Caca K, Schmidt A. Endoscopic removal of over-the-scope clips: Clinical experience with a bipolar cutting device. United Eur Gastroenterol J. 2017;5:479-84

• *
  E-VIDEO: https://youtu.be/N41_qVBEWqA
• Disclosure of funding: no funding received

Publication Dates

• Publication in this collection
  09 Sept 2022
• Date of issue
  Jul-Sep 2022

History

• Received
  20 May 2022
• Accepted
  25 May 2022