Removal of over the scope clips (OTSC) with an Nd:YAG Laser

Until recently there has been no technique available which reproducibly and safely allows endoscopic closures of penetrating defects within the digestive tract. With the new "over the scope clipping system" (OTSC system), which regarding design and function is similar to a bear-trap, a method is available for the endoscopic closure of fistulas and perforations. The OTSC-systems are designed for permanent placement. However, in the case of misplacement or the need to remove the clip after healing of the defect, a technique for destroying and removing the clip should be available. We demonstrate for the first time the successful removal of the deeply penetrating OTSC system by using the Nd:YAG-Laser in 3 cases: (i) after closure of an oesophageal fistula, (ii) after closure of a perforation of the distal common bile duct in the roof of the papilla and (iii) after clip misplacement in a case of a wide oesophagomediastinal fistula resulting in a severe oesophageal stenosis. Clinically relevant thermal lesions were not observed after the procedure. If clinically necessary, the OTSC-system can be safely removed by the Nd:YAG Laser in centres for interventional endoscopy. Because of the small number of cases the method must still be considered as experimental and requires further validation. This will be possible with the help of a newly established OTSC registry ( www.endodo.de ).