Systematic Reviews
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 28, 2020; 26(24): 3495-3516
Published online Jun 28, 2020. doi: 10.3748/wjg.v26.i24.3495
Clinical efficacy of the over-the-scope clip device: A systematic review
Nicholas Bartell, Krystle Bittner, Vivek Kaul, Truptesh H Kothari, Shivangi Kothari
Nicholas Bartell, Krystle Bittner, Vivek Kaul, Truptesh H Kothari, Shivangi Kothari, Division of Gastroenterology and Hepatology, University of Rochester Medical Center, Rochester, NY 14642, United States
Author contributions: Kothari S designed and conceptualized the study; Bartell N and Bittner K collected the data; all authors contributed with planning/conducting the study (literature review), interpretation of data, drafting/editing the manuscript, and approved the final draft.
Conflict-of-interest statement: All the authors declare that they have no competing interests.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Shivangi Kothari, FACG, FASGE, MD, Associate Professor, Division of Gastroenterology and Hepatology, University of Rochester Medical Center, 601 Elmwood Avenue, Box 646, Rochester, NY 14642, United States. shivangi_kothari@urmc.rochester.edu
Received: February 14, 2020
Peer-review started: February 14, 2020
First decision: April 22, 2020
Revised: May 19, 2020
Accepted: May 30, 2020
Article in press: May 30, 2020
Published online: June 28, 2020
Processing time: 134 Days and 15.6 Hours
Abstract
BACKGROUND

The over-the-scope clip (OTSC) system has been increasingly utilized as a non-surgical option to endoscopically manage refractory gastrointestinal (GI) hemorrhage, perforations/luminal defects and fistulas. Limited data exist evaluating the efficacy and safety of OTSC.

AIM

To determine the clinical success and adverse event (AE) rates of OTSC across all GI indications.

METHODS

A PubMed search was conducted for eligible articles describing the application of the OTSC system for any indication in the GI tract. Any article or case series reporting data for less than 5 total patients was excluded. The primary outcome was the rate of clinical success. Secondary outcomes included: Technical success rate, OTSC-related AE rate and requirement for surgical intervention despite-OTSC placement. Pooled rates (per-indication and overall) were calculated as the number of patients with the event of interest divided by the total number of patients.

RESULTS

A total of 85 articles met our inclusion criteria (n = 3025 patients). OTSC was successfully deployed in 94.4% of patients (n = 2856/3025). The overall rate of clinical success (all indications) was 78.4% (n = 2371/3025). Per-indication clinical success rates were as follows: (1) 86.0% (1120/1303) for GI hemorrhage; (2) 85.3% (399/468) for perforation; (3) 55.8% (347/622) for fistulae; (4) 72.6% (284/391) for anastomotic leaks; (5) 92.8% (205/221) for defect closure following endoscopic resection (e.g., following endoscopic mucosal resection or endoscopic submucosal dissection); and (6) 80.0% (16/20) for stent fixation. AE’s related to the deployment of OTSC were only reported in 64 of 85 studies (n = 1942 patients), with an overall AE rate of 2.1% (n = 40/1942). Salvage surgical intervention was required in 4.7% of patients (n = 143/3025).

CONCLUSION

This systematic review demonstrates that the OTSC system is a safe and effective endoscopic therapy to manage GI hemorrhage, perforations, anastomotic leaks, defects created by endoscopic resections and for stent fixation. Clinical success in fistula management appears limited. Further studies, including randomized controlled trials comparing OTSC with conventional and/or surgical therapies, are needed to determine which indication(s) are the most effective for its use.

Keywords: Over-the-scope clip; Hemostasis; Perforation; Fistula closure; Endoscopic resection; Anastomotic leak; Ovesco Endoscopy

Core tip: This systematic review demonstrates that the over-the-scope clip (OTSC) system is a safe and effective endoscopic therapy to manage gastrointestinal hemorrhage, perforations, anastomotic leaks, defects created by endoscopic resections and for stent fixation. Clinical success in fistula management appears limited. Further studies, including randomized controlled trials comparing OTSC with conventional and/or surgical therapies, are needed to determine which indication(s) are the most effective for its use.