Over-the-scope clip (Ovesco) for High Risk Duodenal Ulcer (Forrest Ia-IIc)

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By Dr. Jay Bapaye and Dr. Diana Dougherty

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By Dr. Jay Bapaye and Dr. Diana Dougherty

Elderly lady taking lots of NSAIDs presented with melena. EGD showed kissing ulcers, with the one between duodenal bulb and second duodenum showing active bleeding and an adherent (non-removable) blood clot (red square).

There are several options to treat this high-risk ulcer: a) injection and through-the-scope clips, b) injection and heater probe coagulation, c) injection of fibrin glue, d) over-the-scope clip. Removing the clot could be risky and result in more bleeding. Injecting some slaine-epinephrine is always ood to create some "tamponade" and short vasoconstriction. Also, injection creates a cushion in case heater probe is applied (diminishing risk of perforation). Placing through the scope clips is a good option. However, the big clot may preclude targeting the visible vessel or base of ulcer. The location of the ulcer was also ideal for "en face" approach with cap-clip (OTSC). Thus, we elected to use one-stop approach: over-the scope clip (11/6t, Ovesco)

Clinical endoscopic image

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About the authors

Jay Bapaye, MD

Gastroenterology Fellow, PGY-6

Carilion Clinic / Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA

Jay Amol Bapaye, MD, is a senior gastroenterology fellow at Carilion Clinic and Virginia Tech Carilion School of Medicine. He received his medical degree from Smt. Kashibai Navale Medical College and Hospital in Pune, India, and completed his internal medicine residency at Rochester General Hospital. His research interests include advanced endoscopy, peroral endoscopic myotomy, and EUS-guided interventions, with publications in journals including Digestive Endoscopy and Endoscopy.

Diana L. Dougherty, MD, MPH

Associate Program Director, Gastroenterology Fellowship

Carilion Clinic / Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA

Diana L. Dougherty, MD, MPH, is the Associate Program Director of the Gastroenterology Fellowship at Carilion Clinic and Virginia Tech Carilion School of Medicine in Roanoke, Virginia. She earned her medical degree from Drexel University College of Medicine and completed her internal medicine residency at the National Capital Consortium before joining the Carilion gastroenterology faculty after fellowship training.

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