Over-the-scope clip for acute esophageal variceal bleeding

Area of Science:

• Gastroenterology
• Endoscopy
• Hepatology

Background:

• Acute variceal hemorrhage (AVH) poses a significant risk in patients with portal hypertension.
• Endoscopic band ligation (EBL) is a primary treatment, but failure necessitates alternative strategies.
• The utility of over-the-scope clips (OTSC) for AVH, particularly after EBL failure, remains underexplored.

Purpose of the Study:

• To evaluate the technical success and safety of using OTSC for managing AVH in patients with small varices.
• To assess OTSC as a rescue therapy following failed endoscopic band ligation.
• To report clinical outcomes and potential complications associated with OTSC in this specific patient group.

Main Methods:

• A retrospective case series involving five adult patients with AVH due to small varices.
• OTSC (type 'a', 11 mm cap) was deployed after documented EBL failure.
• Patients had chronic liver disease with portal hypertension (mean HVPG 14.4 mmHg).

Main Results:

• Successful hemostasis of AVH was achieved in all five patients using OTSC.
• No clip-related adverse events occurred within the 30-day follow-up period.
• Two patients experienced transient dysphagia after 3 months, resolved by clip removal.

Conclusions:

• OTSC demonstrates preliminary efficacy and safety as a rescue treatment for acute variceal hemorrhage in small varices post-EBL failure.
• OTSC can be a valuable endoscopic tool for managing refractory variceal bleeding.
• Esophageal dysphagia is a potential complication, manageable with clip removal.