Over-the-Scope Clips (OTSC) are commonly used for haemostasis and defect closure, but removal may occasionally be required. The standard method is the bipolar  cutter system, though no formal guidelines exist. We describe an alternative ESD-based technique when conventional removal fails.

An 81-year-old male patient underwent piecemeal EMR for a 35 mm rectal lesion after ESD was aborted due to severe bleeding, requiring OTSC placement. Two years later, recurrence was detected around and within the  clip, with biopsies showing adenoma with low-grade dysplasia. Attempts to remove the OTSC with the bipolar  cutter system were unsuccessful.

An ESD approach was performed under conscious sedation, using, allowing complete OTSC removal without adverse events. Three-month follow-up confirmed no recurrence.