Over‐the‐scope clip system: A review of 1517 cases over 9 years

Abstract

Rescue therapy for gastrointestinal (GI) refractory bleeding, perforation, and fistula has traditionally required surgical interventions owing to the limited performance of conventional endoscopic instruments and techniques. An innovative clipping system, the over-the-scope clip (OTSC), may play an important role in rescue therapy. This innovative device is proposed as the final option in endoscopic treatment. The device presents several advantages including having a powerful sewing force for closure of GI defects using a simple mechanism and also having an innovative feature, whereby a large defect and fistula can be sealed using accessory forceps. Consequently, it is able to provide outstanding clinical effects for rescue therapy. This review clarifies the current status and limitations of OTSC according to different indications of GI refractory disease, including refractory bleeding, perforation, fistula, and anastomotic dehiscence. An extensive literature search identified studies reported 10 or more cases in which the OTSC system was applied. A total of 1517 cases described in 30 articles between 2010 and 2018 were retrieved. The clinical success rates and complications were calculated overall and for each indication. The average clinical success rate was 78% (n = 1517) overall, 85% for bleeding (n = 559), 85% (n = 351) for perforation, 52% (n = 388) for fistula, 66% (n = 97) for anastomotic dehiscence, and 95% (n = 122) for other conditions, respectively. The overall and severe OTSC-associated complications were 1.7% (n = 23) and 0.59% (n = 9), respectively. This review concludes that the OTSC system may serve as a safe and productive device for GI refractory diseases, albeit with limited success for fistula.

Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement – Update 2020

“…A similar multicenter cohort study (n = 188) included 10 patients with esophageal iatrogenic perforation, all treated successfully with OTS clipping [33]. A large systematic review of patients all treated with OTS clipping (n = 1517 cases; total GI perforations, n = 351) concluded that the mean success rate when using OTS clips for treatment of perforation was 84.6 % (297/351 cases) [37]. These results included perforations throughout the GI tract; nevertheless, iatrogenic perforation in the esophagus may be difficult to close because of the tubular esophageal anatomy [37,76].…”

“…A large systematic review of patients all treated with OTS clipping (n = 1517 cases; total GI perforations, n = 351) concluded that the mean success rate when using OTS clips for treatment of perforation was 84.6 % (297/351 cases) [37]. These results included perforations throughout the GI tract; nevertheless, iatrogenic perforation in the esophagus may be difficult to close because of the tubular esophageal anatomy [37,76]. Hagel et al concluded that defects located in the proximal and mid esophagus, greater than 20 mm in size, with ischemic or congested margins, or present for longer than 72 hours, were least amenable to OTS clip closure [76].…”

“…In the case of OTS clipping unavailability, the combined technique using TTS clips plus endoloop can be recommended [128,129]. A recent review assessing the results for OTS clipping over 9 years in 1517 cases, found clinical success of 84.7 % in 351 cases of iatrogenic perforation [37]. The efficacy for gastric perforation was restricted to defects of size < 40 mm, and OTS clip deployment was contraindicated in cases of stenosis.…”

“…The efficacy for gastric perforation was restricted to defects of size < 40 mm, and OTS clip deployment was contraindicated in cases of stenosis. In some cases, the OTS clipping system was efficient in delayed-onset perforation [37]. The use of the new suturing devices must be restricted to expert centers and/or the setting of clinical trials.…”

Unprecedented problems and troubleshooting during over‐the‐scope clip system use: Suction error and suture cutting procedure

“…Use of the over‐the‐scope clip (OTSC) system is safe and effective for hemostasis in gastrointestinal bleeding, closure of fistula, iatrogenic gastrointestinal perforations, and preventing delayed perforation after duodenal endoscopic resection . Furthermore, we developed a novel endoscopic mucosal resection method with OTSC (EMRO) .…”