Applicability, efficacy and safety of over-the-scope clips in children.

Abstract

BACKGROUND AND AIMS\nOver-the-scope clips (OTSCs) are now becoming popular in endoscopy performed in adults for indications such as acute nonvariceal gastrointestinal bleeding, anastomotic bleeding, and for closure of gastrocutaneous and postgastrostomy fistulae. Varied sizes of clip are available but even the smallest, which is 8.5 to 9.8mm in diameter with its loading device on the tip of the endoscope, increases the device and endoscope intubation diameter up to 14.65mm. This may present challenges in terms of the size of the patient in whom it might be used. They appear to be effective and safe in the hands of those who are trained appropriately in endoscopy on adult patients; however the experience of OTSC application in children is not reported. We present here results of a service evaluation of this technology at 2 regional/national referral pediatric endoscopy units in the United Kingdom and in the United States.\n\n\nMETHODS\nTwo tertiary centers databases were searched to identify cases in which OTSCs were used. Demographics, presentation, anthropometry, co-morbidities, efficacy, adverse events and postprocedure follow-up were recorded, with identification of resolution or recurrence.\n\n\nRESULTS\nOTSC procedures were performed on 24 occasions in 20 patients (11 female) between February 2018 and February 2021. Mean age was 12 (range 5-17) years. Mean weight was 44.42 (range 18.2-70.3) kg. Indications included nonhealing percutaneous endoscopic gastrostomy (PEG) site fistulae (7), acute nonvariceal upper gastrointestinal bleeding (ANUGIB) from gastric ulcers (5), ANUGIB from duodenal ulcers (3), nonhealing bleeding anastomotic ulcer (3), esophageal mucocutaneous fistula (1), and gastric perforation (1). Technical success was achieved in all but 1 case (95%), and clinical success was achieved in 18 cases (90%).\n\n\nCONCLUSIONS\nThe OTSC device appears effective in children (minimum age 5 years and minimum weight 18 kg) in a limited number of situations including anastomotic ulcer, closure of leaking PEG site, gastric perforation and bleeding peptic ulcers. The operator should be an experienced endotherapeutic endoscopist with specific OTSC training, and the type and size of the OTSC device should be carefully considered, along with any co-morbidities of the patient that may preclude success and/or lead to potential adverse events such as esophageal perforation.