OTSC for Duodenal Ulcer Bleeding: A One-Stop Solution for Challenging Cases

When faced with active duodenal ulcer bleeding, particularly in anatomically challenging locations, the Over-The-Scope Clip (OTSC) can be your best friend. Today I want to share a case that perfectly demonstrates why this tool should be in every endoscopist’s arsenal for high-risk bleeding scenarios.

The Clinical Challenge

This patient presented with active bleeding from a duodenal ulcer located at the junction between the bulb and second portion of the duodenum. After requiring four units of packed red blood cells, urgent endoscopic intervention was needed. The ulcer showed a large visible vessel, making it an ideal candidate for OTSC placement.

The anatomical location presented several challenges. Entry into the duodenal bulb was difficult, and maintaining stable scope position was challenging due to the patient’s short bulb anatomy. However, these very challenges made the case perfect for demonstrating the advantages of cap-assisted OTSC placement.