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An uncommon problem of over-the-scope clip positioning is abdominal obstruction brought on by luminal stenosis during the site of clip positioning. Abdominal obstruction can seldom trigger other downstream complications such as hydronephrosis from extrinsic compression associated with endocrine system. We report an unusual case of bilateral hydronephrosis brought on by bowel obstruction from a migrated endoscopically placed clip. © 2019 The Author(s). Published by Wolters Kluwer Hea