Over-the-Scope Clip (OTSC) System for Sleeve Gastrectomy Leaks

Abstract

The success rate was high with the OTSC system, and it is concluded to be a safe and effective treatment for LSG leaks.

Management of Distal Gastric Leak After Laparoscopic Sleeve Gastrectomy by Double Pigtail Catheter

“…To overcome these challenges, extra-long, covered,self-expandable endoluminal stents have been developed whose use may decrease theincidence of stent-specific complications [7].Use of over-thescope clip (OTSC) is another approach that appears promising in bariatric surgery. In a recent case series, Keren et alfoundan 80.7% success rate using OTSC [8]. However, theyreported that 26.9% of the patients examined needed additional endoscopic treatment and that only 2 out of 4 patients with antral leaks were treated.…”

Endoluminal solutions to bariatric surgery complications: A review with a focus on technical aspects and results

“…Limited data about the use of through-the-scope clips in this indication fail to show any advantage of these clips in post-bariatric leaks. Preliminary experience with a new clipping device made of nitinol and loaded at the tip of the endoscope, over-the-scope clip (OTSC) (Ovesco Endoscopy, Tübingen, Germany) seems promising (Figure 4)[111,121-123]. This clip allows full thickness apposition in wall defects smaller than 3 cm.…”

“…Before placing the OTSC, appropriate drainage of leaked material is required as for SEES and it is strongly advised to de-epithelialize the fistula edges either with a cytology brush or with argon plasma coagulation to promote granulation tissue. In two studies reporting on 18 and 26 patients with SG leaks, leak closure was possible in 81% and 89%[122,123]. However, several patients in both studies also received a SEMS, resulting in 61% and 62% of primary success.…”

Endoscopic management of bariatric surgical complications

“…De-epithelialization of the leak site and absence of infection behind the orifice of the leak prior to commencement of primary closure is mandatory [40,41]. Primary closure was conventionally performed with biological glue or through-the-scope clips although durable closure was rarely achieved and we recommend against the use of such techniques [42,43].…”

“…Primary closure was conventionally performed with biological glue or through-the-scope clips although durable closure was rarely achieved and we recommend against the use of such techniques [42,43]. Small series reporting the use of the OTSC (Ovesco AG, Tubingen, Germany) have revealed promising results with one retrospective study of 26 patients reporting an 81% closure rate using the OTSC for acute or early leaks after sleeve gastrectomy leaks at a median of 32 days [41]. However, the number of endoscopy sessions for each patient ranged from two to seven and 27% underwent additional endoscopic techniques (biological glue, stent insertion, etc.).…”