The clip Ovesco (Ovesco, Tübingen, Germany) is a novel endoscopic method for mechanical compression of tissue in the gastrointestinal tract. The indications for treatment are closure of perforations and fistulas and control of bleeding in which the conventional endoscopic treatment has failed. We report two cases about the use of an Ovesco (over-the-scope clip, OTSC) system to control persistent bleeding postpolypectomy after failure of usual treatment.Key words: Ovesco. Nitinol clip. Hemostasis. Gastrointestinal bleeding. CASE REPORTS Case report 1A 65-year-old woman with no medical history of interest underwent gastroscopy due to iron-deficiency anemia. A 4-cm pedunculated polyp with wide stalk in the antrum was noted. Polypectomy was performed with a snare after injection with epinephrine. Immediately, it showed arterial bleeding that was treated unsuccessfully with sclerotherapy with epinephrine and etoxiesclerol and application of endoclips (Olympus, Hamburg, Germany) ( Fig. 1 A-C). Therefore, placement of an Ovesco with rounded edges by its insertion in the distal end of a therapeutic gastroscope (Olympus GIF 1TQ160) was decided. Bleeding was very profuse and prevented from locating the bleeding vessel. The anchor was used to bind tissue margins and to pull them into the cap before clip release. Hemostasis was achieved promptly (Fig. 2). Case report 2An ambulatory colonoscopy was performed on a 71-yearold woman for colorectal cancer screening. The patient was carrier of a prosthetic metal heart valve in mitral position. Prior to colonoscopy, oral anticoagulant was retired according to hospital protocol. Two sessile polyps of 15-mm and 20-mm were removed in sigma by a snare polypectomy and previous submucosa injection of epinephrine. Three days after, the patient was admitted into hospital with rectal bleeding. Laboratory test revealed hemoglobin of 9.7 g/dL. A new colonoscopy was performed, an adherent clot in the proximal polypectomy was observed (Fig. 3). It was removed and two hemoclips were placed. Base of resection from the distal polypectomy was covered with fibrin without bleeding. However, three days later, the patient began with new episode of rectal bleeding. It was noted a clot in the base of resection from the proximal polypectomy and hemoclips were gone. It was placed endoclips and endoloop closure technique (Fig. 4). A clip was applied in the distal polypectomy for added security although it did not show any signs of bleeding. Sodium heparin intravenous infusion was started since it was not possible to reintroduce anticoagulant oral and the risk of recurrent rectal bleeding. The patient was attended again, 48 hours later, because of another episode of rectal bleeding from ulcer caused by clips of the base of resection from proximal polypectomy (Fig. 5A). An OTSC was used at that time because of the failure to control bleeding using conventional endoscopic treatments. Same endoscope and kind of OTSC as in previ- Rev Esp Enferm Dig 2014;106:55-58.
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