Original article
Experimental endoscopy
Hemodynamic efficacy of the over-the-scope clip in an established porcine cadaveric model for spurting bleeding

https://doi.org/10.1016/j.gie.2011.08.009Get rights and content

Background

Clip application has been proven to be effective for endoscopic hemostasis. There are limited bench data on the efficacy of the over-the-scope clip (OTSC) for the treatment of spurting GI hemorrhage. We evaluated the hemodynamic efficacy of the OTSC in an established bleeding model.

Objective

To evaluate the hemodynamic efficacy of the OTSC in an established bleeding model.

Design

Prospective experimental trial with historical comparison.

Setting

We tested the OTSC prospectively in a validated bleeding model by using the compact Erlangen Active Simulator for Interventional Endoscopy equipped with an upper GI organ package. The artificial blood circulation system of the simulator was connected to an arterial pressure transducer. Two investigators with different endoscopic experience (4000 and 10,000 endoscopies performed) participated. Each investigator treated 16 bleeding sites in the simulator with the OTSC by using only suction (n = 8) and a novel retraction device to grasp tissue (n = 8). Systemic pressures were recorded 1 minute before, during, and 1 minute after clip application to objectify the effects of clipping on the vessel diameter.

Main Outcome Measurements

Mean and maximum reduction in vessel diameter.

Results

The application of the OTSC on the bleeding vessel led to a significant increase in systemic pressure (P < .001) and decreased vessel diameter (P < .001) independent of the endoscopic experience of the investigator. There was no difference in the decrease in vessel diameter based on the application technique (suction vs suction plus grasping). A historical comparison with our former trials demonstrated that the OTSC decreased the vessel diameter significantly more than other traditional endoclips.

Limitations

Small sample size.

Conclusions

We could demonstrate the efficacy of the OTSC with increased hemodynamic efficiency compared with other endoscopic clip devices tested previously.

Section snippets

Study design

The study was designed as a prospective trial comparing 2 endoscopists of differing expertise (4000 and 10,000 endoscopies performed, both with experience in emergency endoscopy service) to induce hemostasis with the OTSC application device (Ovesco Endoscopy AG, Tübingen, Germany)5 in an established experimental setup with the compact Erlangen Active Simulator for Interventional Endoscopy cadaveric endoscopy simulator equipped with an upper GI organ package for bleeding simulation as described

Results

Complete pressure curves were documented for all 32 bleeding sources. A total of 32 clips were applied. We observed a significant increase in the mean pressure (from 97.6 ± 29.5 mm Hg to 240.5 ± 67.3 mm Hg; P < .001) resulting also in a significant decrease in the mean vessel diameter (19.8 ± 7.4%; P < .001) (Table 1). The maximum recordable pressure was achieved in 19 of 32 bleeding sources (59%).

Discussion

In the underlying experimental study, we tested a new OTSC application device with different properties of other commercially available endoclips designed for use through the working channel of the endoscope. The traditional devices have shown their efficacy in various experimental and clinical prospective trials.8, 9, 10, 11, 12, 13, 14, 15 The mechanism of action of clipping devices is the compression of the vessel by grasping the surrounding tissue. This explains the significantly better

Acknowledgments

We thank Ovesco Endoscopy AG, Tübingen, Germany, for supporting this study by supplying the OTSC devices. Ex vivo specimens and compact Erlangen Active Simulators for Interventional Endoscopy were provided by the Association for Quality-Oriented Training in Endoscopy e.V. Erlangen, a nonprofit organization that aims to research the value of training and testing in endoscopy.

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  • Cited by (0)

    DISCLOSURE: The following author disclosed a financial relationship relevant to this publication: Dr. Matthes, consultant, Ovesco Endoscopy, USA Inc. The other authors disclosed no financial relationships relevant to this publication.

    If you would like to chat with an author of this article, you may contact Dr Maiss at [email protected] or [email protected].

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