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(OTSC) system, to provide endoscopic hemostasis for bleeding posterior duodenal ulcers The “bear claw”, or over-the-scope clip (OTSC) system (Ovesco Endoscopy, Tübingen, Germany), is an innovative clipping device made of superelastic biocompatible nitinol [1–3]. This device was developed to close wall defects of the luminal gastrointestinal tract, such as perforations, anastomotic leaks, and fistulas [1, 2]. The use of the “bear claw” in humans is still limited, but due to the excellent capabilities of the “bear claw” to close large mucosal defects, more reports on its efficacy are being published [2,3]. Here we present the use of the “bear claw” to provide hemostasis of large ulcers of the posterior duodenal wall. Four patients (three women and one man, ages 82–90, mean age 84.5) presented with massive gastrointestinal bleeding. All of the patients had hypotension upon presentation. The patients’ hemoglobin ranged from 6 to 12g/dL, with a mean of 9g/dL (normal 12–18g/dL). All patients Fig.1 The cap with the over-the-scope clip (OTSC) is loaded onto the tip of the scope, similarly to the esophageal banding device.

Utility of the “bear claw”, or over-the-scope clip (OTSC) system, to provide endoscopic hemostasis for bleeding posterior duodenal ulcers