331 Over-the-Scope Clip (Ovesco) Deployment for Life-Threatening Duodenal Ulcer Bleed: A Video Case Report in an Elderly Patient

Abstract Massive upper gastrointestinal bleeding from a duodenal ulcer (DU) remains a critical emergency, particularly in elderly patients were comorbidities limit tolerance to surgery. We present the case of an 87-year-old female with large DU at the apex of the duodenal bulb, previously treated with endotherapy, who collapsed with fresh haematemesis in hospital. Emergency oesophagogastroduodenoscopy (OGD) revealed a large clot adherent to a cratered ulcer at the D1 apex. On clot removal, a pulsatile vessel was seen with active spurting. Initial haemostasis was attempted with adrenaline injection and thermal coagulation. A 16 mm clip was placed for localisation, but bleeding persisted. An Ovesco (over-the-scope clip, OTSC) was deployed, capturing the ulcer base and achieving haemostasis. A second potential bleeding point became apparent and a second Ovesco was deployed to fully secure haemostasis. The vessel was noted to be drawing into the Ovesco cap before firing, confirming optimal clip capture. No further bleeding occurred. This case demonstrates the utility of Ovesco clips in managing refractory DU bleeding, particularly in challenging locations like the D1 apex. OTSC clips enable full-thickness tissue to capture and provide durable haemostasis, even after failure of conventional modalities[1–3]. Ovesco application can be a life-saving option in select high-risk patients.