Introductions Over The Scope Clips (OTSC)® have developed valuable indications in adult endoscopy. These indications include: non-variceal gastrointestinal (GI) bleeding, anastomotic bleeding, closure of fistulae such as gastro-cutaneous and post-gastrostomypersistent fistulae closure. Different clip sizes are available, the smallest being 8.5–9.8 mm in diameter with its loading device on the tip of the endoscope increasing the device and endoscope intubation diameter to 14.6 mm. This may present challenges in terms of the size of the patient in whom it might be used. OTSC® appear effective and safe when appropriate training is received in adult interventional endoscopy. There are no reported case series of OTSC® in children. We undertook a service evaluation of our recent experience with this technology in a regional/national referral paediatric endoscopy unit.

Methods The hospital database was searched to identify cases where OTSC® was used for indications other than acute non-variceal GI bleeding. A retrospective collection of data including demographics, presentation, anthropometry, co-morbidities, efficacy and complications was done. Post-procedure follow up was identified in the clinic or in-patient setting. Special emphasis was laid on resolution or recurrence of the original indication, and any complications related to the procedure.

Results Seven patients (3 male) were identified in whom the OTSC® procedure had been performed between February 2018 and February 2020. Median age was 10.8 (range 5.2–16.6) years. Median weight was 27.08 (range 18.2–44.3) kg. The patient profile, indications for the procedure and the outcome are detailed in table 1. Successful outcome was achieved in 5/7 patients and a complication of an oesophageal perforation occurred in 1/7 which healed without surgical intervention.

Conclusion The OTSC® device appears effective in a limited number of situations in older and larger children including anastomotic ulcers, closure of leaking percutaneous endoscopic gastrostomy (PEG) fistula/site following removal, gastric perforation and bleeding peptic ulcers. The operator should be an experienced endo-therapeutic endoscopist with specific OTSC® training, and the type and size of the OTSC® device should be carefully considered, along with any co-morbidities of the patient that may preclude success and/or lead to potential complications such as oesophageal perforation.