S711 Safety and Efficacy of Over-The-Scope Clip Systems in Patients Undergoing Gastrointestinal Endoscopy With Moderate Sedation: A Preliminary Analysis

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Introduction: Over-the-scope-clip (OTSC) systems are increasingly used to manage gastrointestinal bleeding (GIB), perforations, fistulae, and anastomotic leaks. In the United States, most cases are performed with anesthesia assistance using general or monitored anesthesia care (MAC). Data is limited regarding the safety and efficacy of these systems during gastrointestinal (GI) endoscopic procedures under moderate sedation. This study aims to evaluate the safety and efficacy of OTSC systems use in gastrointestinal (GI) endoscopic procedures performed under moderate sedation. Methods: This study is a single center, retrospective analysis of consecutive patients between 2018 and 2021 who underwent GI endoscopic procedures for GIB and fistula closure utilizing OTSC systems. Only procedures done under moderate sedation (midazolam and/or fentanyl) were included. Patient and procedural characteristics were noted. Primary outcomes were technical success and adverse events. Secondary outcomes were clinical success and requirement of a salvage procedure [surgery or interventional radiology (IR)] intervention. Results: A total of 15 patients were included. Upper endoscopy was performed in 11, while lower endoscopy was performed in 4 (Table 1). Procedure indications were GIB and fistulae closures. Technical success was 100%. There was only one minor adverse event; minor and self-limited oropharyngeal bleed resulting from insertion of a clip. All patients tolerated moderate sedation well with mean fentanyl and midazolam doses of 109 mcg and 4.6 mg, respectively. Mean procedural duration was 29.8 minutes. Hemostasis was achieved in all cases of GIB except one requiring subsequent IR embolization for hemostasis. All cases for fistulae closure were successful. Therefore, clinical success was achieved in 14 cases (93.3%). There were no cases of mortality. Conclusion: Our study demonstrates that OTSC systems can be safely and effectively used in patients undergoing GI endoscopy under moderate sedation. Our preliminary analysis provides encouraging information for endoscopists in the United States who perform majority of their endoscopy cases with moderate sedation, and for practices where anesthesia use is limited due to resource constraints. Table 1. - Patient Demographic and Clinical Information of OTSC Application Patient Number Age of Patient, yr Gender Clinical Condition Comorbidities Anticoagulation/Antiplatelet use 1 47 Male Colonic polyp bleed HTN, CAD, CHF, OSA, VALVULAR DISEASE Yes 2 56 Male Colonic polyp bleed with colonic mass NONE No 3 61 Male Gastric fistula NONE No 4 62 Female Gastric fistula NONE Yes 5 67 Male Surgical site bleed in stomach HTN, DM, CAD Yes 6 68 Male Colonic polyp bleed with colonic mass DM Yes 7 68 Male Gastric polyp bleed HTN No 8 69 Male Duodenal ulcer bleed HTN, DM, CAD, CKD/ESRD, OBESITY Yes 9 71 Male Gastric ulcer bleed HTN, DM, CAD, OBESITY No 10 73 Male Gastric fistula HTN, OSA No 11 78 Male Duodenal ulcer bleed HTN, DM, CAD, CKD/ESRD, CHF, VALVULAR DISEASE Yes 12 86 Male Duodenal ulcer bleed HTN, CAD, VALVULAR DISEASE Yes 13 88 Male Gastric ulcer bleed HTN, DM, CKD/ESRD, CHF, OBESITY Yes 14 88 Male Gastric ulcer bleed HTN, CAD, CHF, COPD, VALVULAR DISEASE No 15 90 Male Gastric ulcer bleed HTN, VALVULAR DISEASE No Abbreviations: HTN: Hypertension, CAD: Coronary Artery Disease, CHF: Congestive Heart Failure, OSA: Obstructive Sleep Apnea, DM: Diabetes Mellitus, CKD/ESRD: Chronic Kidney Disease/End Stage Renal Disease, COPD: Chronic Obstructive Pulmonary Disease.

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