Over-The-Scope Clip Misdeployment Resulting in Acute Cholangitis and Biliary Pancreatitis.

Over-the-scope clips (OTSCs) have improved the endoscopic management of acute nonvariceal upper gastrointestinal bleeding. They allow for effective hemostasis of high-risk lesions in challenging locations and have been shown to be superior to through-the-scope clips. However, misdeployment of OTSCs may be associated with obstructive complications. In this study, we present the case of a 67-year-old man who developed recurrent gastrointestinal bleeding from a duodenal ulcer. His course was ultimately complicated by acute cholangitis and pancreatitis from a misdeployed OTSC around the ampulla. Endoscopic management was pursued, and the clip was successfully retracted with resolution of his biliary obstruction and subsequent clinical improvement.