Expanded options for removal of an old over-the-scope clip

The use of the over-the-scope clip (OTSC) is gaining popularity. A bipolar OTSC removal device can be used to remove the OTSC if clinically indicated. We presented a case that illustrated the difficulty when removing an old OTSC and how to tackle it.

A 64-year-old man had an OTSC in situ for 990 days from a previous OTSC-assisted endoscopic full-thickness resection of a gastric subepithelial lesion. There was a thick coating on the clip, and the OTSC removal device (remOVE System; Ovesco Endoscopy AG, Tübingen, Germany) could not cut the clip because of impaired conduction of current. The clip was scratched by biopsy forceps and cytology brush, but the coating remained.

A disposable cleaning brush was used to clean the surface of the clip, and the metal surface of the clip emerged. The OTSC removal device was able to deliver the current to the clip and fragment the clip. The 2 fragments of the clip were removed from the mouth after dragging the fragments into the protective plastic cap. There was no immediate adverse event.

Our case demonstrated that an OTSC can be removed by the bipolar OTSC removal device even if it was left in the GI tract for a long period.