Duodenal Obstruction Secondary To Over-The-Scope Clip Application

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Introduction

Over-the-scope clips (OTSC) are used increasingly to treat gastrointestinal haemorrhage when first-line therapies fail. In addition to haemorrhage, indications include perforation, gastrostomy closure and stent fixation. There is limited data on complications of OTSC application. Studies have shown that deployment failure and perforation are the leading complications of its use. Despite this, it remains a safe and effective treatment even in spontaneous detachment. This report details a case of duodenal obstruction secondary to OTSC placement.

Case Report 

A 73-year-old female patient presented with epigastric pain and PR bleeding. Her serum haemoglobin was 52. She received blood products and was discharged to undergo urgent outpatient endoscopic investigations. She re-presented one week later with similar symptoms and was hypotensive. An urgent OGD demonstrated a Forrest IA duodenal ulcer with spurting haemorrhage. An OTSC was placed and she was discharged on H. pylori eradication therapy. She re-presented again with vomiting and epigastric pain. Repeat endoscopy demonstrated a traversable stricture and benign tissue overlying the OTSC. The device was unremovable so a hot snare technique was used to excise the tissue. Balloon dilatation targeted the stricture and she was discharged on soft diet to be gradually increased to solid food.

Discussion

Mucosal hyperplasia overlying the OTSC in combination with stricturing from inflammation around a healing ulcer gave rise to duodenal obstruction. Studies show that OTSC removal is complicated by overlying tissue, however there is no data describing duodenal obstruction secondary to mucosal hyperplasia.