Use of over-the-scope clips (OTSC) for hemostasis in gastrointestinal bleeding in patients under antithrombotic therapy.

Background and study aims In patients taking different regimens of antithrombotic and/or anticoagulant therapy, endoscopic management of gastrointestinal bleeding represents a major challenge due to failing endogenous hemostasis. In this retrospective study we report on success rates with the over-the-scope clip (OTSC) system in upper and lower gastrointestinal bleeding in this high-risk patient population. Patients and methods Between February 2011 and June 2014, 75 patients were treated with an OTSC for active gastrointestinal bleeding. Success rates with the first endoscopic therapy, rebleeding episodes, their management and the influence of antithrombotic or anticoagulant therapy were analyzed retrospectively. Results Application of the OTSC resulted in immediate hemostasis (primary success rate) in all 75 patients. However, in 34.7 % a rebleeding episode was noted that could be treated by further endoscopic interventions. Only 3 patients had to be sent to the operating room because of failure of endoscopic therapy. In the rebleeding group the use of antiplatelet therapies was higher (73.1 % vs. 48.9 %). Conclusions Application of the OTSC in GI bleeding results in a high rate of primary hemostasis. Rebleeding occurs in up to 35 % of patients receiving antithrombotic/anticoagulant therapy but can be managed successfully with further endoscopic treatments. Patients in the rebleeding group were more frequently treated with antiplatelet agents. Radiological or surgical therapy was reserved for a small subgroup not successfully managed by repeated endoscopic therapies. OTSC application is the treatment of choice in high-risk patients when conventional clips used as first-line treatment fail.

Thermal esophageal lesions after radiofrequency catheter ablation of left atrial arrhythmias.

OBJECTIVES: Radiofrequency catheter ablation in patients with left atrial arrhythmias may cause esophageal damage because of the close proximity between the posterior wall of the left atrium and the esophagus. The aim of this prospective study was to determine the incidence, endoscopic characterization, and endoluminal temperature dependency of esophageal thermal lesions after catheter ablation. METHODS: In all, 185 consecutive patients with symptomatic atrial fibrillation or left atrial macro-re-entrant tachycardia who underwent left atrial radiofrequency catheter ablation were scheduled for upper gastrointestinal endoscopy. During the ablation procedure, a non-fluoroscopic three-dimensional system for catheter orientation, computed tomography (CT) image integration, and activation mapping was used. The esophagus was intubated with a temperature probe for visualization within the three-dimensional image and for real-time intraluminal temperature monitoring. RESULTS: A total of 27 (14.6%) asymptomatic ulcer-like or hemorrhagic esophageal thermal lesions with a diameter of 2-16 mm were observed. Esophageal lesions did not occur below an intraluminal esophageal temperature of 41 degrees C. The maximal temperature in the esophagus was significantly higher in patients with thermal lesions than in patients without lesions (42.6+/-1.7 degrees C vs. 41.4+/-1.7 degrees C, P=0.003). For every 1 degrees C increase in endoluminal temperature, the odds of an esophageal lesion increased by a factor of 1.36 (95% confidence interval (CI) 1.07-1.74, P=0.012). No progression of the lesions was observed during follow-up endoscopies. CONCLUSIONS: Localized esophageal ulcer-like lesion is a frequent event after left atrial catheter ablation and can be found in patients whose intraluminal temperature has reached at least 41 degrees C.