Post written by Ka-Kin Sze, FHKCP, from the Division of Gastroenterology and Hepatology, Department of Medicine and Geriatrics, Tuen Mun Hospital, Tuen Mun, Hong Kong SAR, China.

We present a case of a patient who had an over-the-scope clip (OTSC) in situ for more than 2 years. A decision was made to remove the OTSC using the OTSC removal device (remOVE System; Ovesco Endoscopy AG, Tübingen, Germany) to facilitate subsequent management.

However, the removal device was unable to cut the OTSC because of a thick coating on the surface of the clip impairing the cutting mechanism. Attempts to use biopsy forceps and a cytology brush to clean the OTSC failed.

We finally adopted a brushing technique that involved a single-use disposable cleaning brush and a dual-channel gastroscope (GIF-2TQ260M; Olympus, Tokyo, Japan) to clean the surface of the OTSC, which was removed successfully at the end of the procedure.

The use of OTSCs is gaining popularity. The common indications include closing perforation, hemostasis, and endoscopic resection. Although the majority of the OTSC dislodges spontaneously, there are circumstances when endoscopists or patients would prefer the OTSC to be removed electively because of various reasons. The rate of successful removal of the OTSC is not 100%, especially in cases where the clips were left for a long time, or the orientation of the OTSC was unfavorable for the removal device.

By using the brushing technique, we cleaned the surface of the OTSC and could remove the clip successfully. Our technique ensures the timely removal of the OTSC instead of passively hoping for spontaneous disposal of the OTSC. This technique should be considered, especially with difficulties of OTSC removal because of thick covering of the OTSC or poor orientation of the instrument.

Endoscopic view of the over-the-scope clip (OTSC) with metal surface exposed after cleaning with the disposable cleaning brush. The OTSC was held by a grasper, and the direct current cutter made efficient contact with the metal surface of the OTSC.

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