Methods for Endoscopic Removal of Over-the-Scope Clip: A Systematic Review

Abstract

Aims. The over-the-scope clip (OTSC) has recently emerged as a new endoscopic device for treating gastrointestinal bleeding, perforations, fistulas, and leaks. A modified OTSC device (full-thickness resection device, FTRD) has been widely used for endoscopic full-thickness resection. However, there is less experience regarding the indications and methods for OTSC removal. We aimed to summarize the existing methods and indications for OTSC removal. Methods. We searched PubMed, Cochrane Library, and ClinicalTrials.gov to identify relevant publications on OTSC removal. The details of OTSC removal, including the methods, indications, success rates, adverse events, and failure causes, were extracted and summarized. A meta-analysis of pooled success rates was conducted using STATA 15.0. Results. Eighteen articles were included. The reported methods for OTSC removal included (1) grasping forceps, (2) the Nd : YAG laser, (3) argon plasma coagulation, (4) the remOVE system, (5) endoscopic mucosal resection/endoscopic submucosal dissection, and (6) ice-cold saline solution. Indications for OTSC removal were (1) poor healing, (2) OTSC misplacement, (3) repeat biopsy/therapy or further treatment, (4) adverse events after OTSC implantation, (5) removal after recovery, and (6) patient wishes. The pooled success rate of OTSC removal was 89% in patients treated with the remOVE system. Minor bleeding, superficial thermal damage, and superficial mucosal tears were common adverse events. Mucosal overgrowth was the main cause of OTSC removal failure. Conclusions. The remOVE system is the best investigated method, with sufficient efficacy and safety for OTSC removal. This is the first systematic review of OTSC removal and provides significant guidance for clinical practice.

Novel through-the-scope twin clip for the closure of GI wounds: the first experimental survival study in pigs (with videos)

“…OTSCs, an innovative endoscopic treatment device, possess powerful clamping ability and can be used for hemostasis and closure of fistulas. 10,11 However, the OTSC requires installation on the front end of the endoscope before use. Thus, for wound closures after ESD and EFR, withdrawal of the endoscope for installation of the OTSC and reinsertion of the endoscope are required.…”

“…Furthermore, the OTSC does not always spontaneously detach and may be retained for a long time, resulting in peptic ulcers or stenosis. 11,12 Some high-end suturing devices are similar to surgical suturing for wound closure. 6,7 These high-end devices can close large wounds and perform special operations, such as endoscopic sleeve gastroplasty.…”

Endoscopic resection using an over-the-scope clip for duodenal neuroendocrine tumors

“…Use of other removal methods, such as grasping forceps [28], EMR/ESD [29] and ice-cold saline solution [30], also have been reported. The safety and efficacy of these methods are uncertain because they have been described in only a few cases; moreover, the use of these methods is not recommended because they can cause new severe AEs [31]. Considering the above, intentional removal of an OTSC is not realistic; for this reason, sufficient preoperative simulation of OTSC deployment is recommended, as well as limitation of the target to only lesions in which the OTSC can be reliably deployed.…”

Closure techniques in exposed endoscopic full-thickness resection: Overview and future perspectives in the endoscopic suturing era

“…Furthermore, OTSC is relatively quick and simple to use compared with the above-mentioned closure methods. Of note, in cases of OTSC-related complications occurrence or need for re-therapy after incomplete EFTR, safe and effective OTSC removal mainly by means of a dedicated bipolar direct current grasping device (remOVE system, Ovesco, Tuebingen, Germany) has been reported[ 31 ]. However, the use of the OTSC closure method is limited mainly to defects smaller then 20-25 mm, due to the relatively small internal diameter of the device[ 32 - 34 ].…”