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World Journal of Gastroenterology
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1007-9327
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Systematic Reviews
Copyright ©The Author(s) 2020.
World J Gastroenterol. Jun 28, 2020; 26(24): 3495-3516
Published online Jun 28, 2020. doi: 10.3748/wjg.v26.i24.3495
Table 1 Over-the-scope clip types available for endoscope diameter and applicator clip depth2
OTSC cap options
Mini (10)111214
Scope outer diameter compatibility8.5-9.8 mm8.5-11 mm10.5-12 mm11.5-14 mm
Diagnostic gastroscopesDiagnostic gastroscopes1T/2T gastroscopes, peds colonoscopesAdult colonoscopes
Maximum outer diameter of cap14.65 mm16.5 mm17.5 mm21 mm
Thread length165 cm165 cm165 cm or 220 cm220 cm
Depth of applicator cap
3 mma, ta, ta, ta, t
6 mmN/Aa, ta, t, gc1a, t
1Type “a” clips: Blunt teeth; Type “t”: Teeth with small spikes; Type “gc”: Teeth with elongated spikes (only available in size 12 cap); 2Adapted from Over the scope clip System Brochure (Ovesco Endoscopy AG, Tübingen, Germany)[1]. N/A: Not applicable.
Full Size Table
Table 2 Summary of included studies (overall clinical success rate, per-indication clinical success rate, and overall over-the-scope clip-related adverse event rate)
Ref.
Year
Type of study
Country
Patients (n)
Overall clinical success rate (%)
Follow-up (wk)
Adverse events,n (%)
Indications
Total
FistulaBleedingPerforationLeakERStent fixation
Seebach et al[15]2010Case series RetrospectiveSwitzerland7--57.1---57.110-42NR
Kirschniak et al[2]2007RetrospectiveGermany11-100100-100-1001-50.0
Mudumubi et al[16]2014RetrospectiveInternational112-----83.383.33-400.0
Sandmann et al[17]2011Case series RetrospectiveGermany11100-10066100-90.912.7NR
Albert et al[18]2011RetrospectiveGermany19-57.1-66.7--63.21-680.0
Repici et al[19]2009Case series RetrospectiveItaly9-100--100-1004-120.0
Donatelli et al[20]2016RetrospectiveInternational24536.7-100---57.836-1000.0
Maekawa et al[21]2015ProspectiveJapan12----91.7-91.7NR0.0
Gautier et al[22]2015Retrospective Multi-centerFrance1711.8-----11.812NR
Nishiyama et al[23]2013RetrospectiveJapan237577.875-100-82.62-80.0
Voermans et al[24]2012Prospective Multi-centerNetherlands36--88.9---88.91-260.0
Lee et al[26]2017Prospective Multi-centerKorea1925-10083.3100-73.7720.0
Angsuwatcharakon et al[27]2016RetrospectiveThailand6--83.3---83.3NRNR
Arezzo et al[28]2012Case series ProspectiveItaly14---85.7--85.7160.0
Schlag et al[29]2013ProspectiveGermany6--100---1004-120.0
Disibeyaz et al[30]2012Case series RetrospectiveTurkey933.3-10060--55.6NR0.0
Gubler et al[31]2012Case series ProspectiveSwitzerland14--85.7---85.74-48NR
Singhal et al[32]2014Case Series ProspectiveUnited States1090-----9070.0
Mennigen et al[33]2013Case series RetrospectiveGermany1471.4-10083.3--78.61-680.0
Faehndrich et al[34]2015RetrospectiveGermany17----94.1-94.1NR0.0
Schmidt et al[4]2015Prospective Multi-center RCTInternational324----75-7542 (8.3)
Guo et al[35]2015RetrospectiveChina23----100-1004-242 (8.7)
Correia et al[36]2014Case series ProspectivePortugal680-100---83.3NR0.0
Goenka et al[37]2017ProspectiveIndia1266100100---91.74-80.0
Surace et al[38]2011ProspectiveItaly1973.7-----73.7321 (5.3)
Kochhar et al[39]2017Case series ProspectiveUnited States12---66.7--66.7601 (8.3)
Manta et al[40]2017ProspectiveItaly76---80.3--80.3NR0.0
Parodi et al[41]2010ProspectiveItaly1080-10050--80.0NR0.0
Manta et al[42]2011Case series RetrospectiveItaly1287.5--75--83.340.0
Honegger et al[43]2017Retrospective CohortSwitzerland20329.877.486.133.3-66.763.146 (3.0)
Manno et al[44]2015RetrospectiveInternational440-100----10040.0
Richter-Schrag et al[45]2016RetrospectiveGermany100-78----78NRNR
Aepli et al[46]2016RetrospectiveSwitzerland24----87.5-87.5NR4 (16.7)
Law et al[48]2015Retrospective Multi-centerUnited States4753.2-----53.2260.0
Farnik et al[3]2015Retrospective Multi-centerInternational534--10056.3--70.5390.0
Jacobsen et al[49]2012RetrospectiveUnited States100-10080--70.0120.0
Haito-Chavez et al[50]2014Retrospective Multi-centerInternational616142.9-9073.3--60.218 – 300.0
Winder et al[51]2016RetrospectiveUnited States2877.2--100--82.1190.0
Sulz et al[52]2014Case series ProspectiveSwitzerland1954.5100-66.7-10063.1NR0.0
Magdeburg et al[53]2015ProspectiveGermany43--97.8---97.8NR3 (7.0)
Wedi et al[54]2016RetrospectiveFrance8410089.357.1-100-89.3NR2 (2.4)
Keren et al[55]2014Case series ProspectiveIsrael26---80.8--80.8NR0.0
Raithel et al[14]2017Retrospective Multi-centerGermany34--74.185.7--76.5NR3 (8.8)
Kobara et al[56]2017Retrospective Multi-centerJapan5883.383.3-85.7--84.54+1 (1.8)
Hagel et al[57]2012Case series ProspectiveGermany17--64.7---64.74NR
Nasa et al[58]2016Case series RetrospectiveIndia780100100---85.745NR
Skinner et al[6]2014RetrospectiveUnited States12-83.3----83.310 – 300.0
Al-Bawardy et al[59]2017RetrospectiveUnited States7----100-1001 – 860.0
Sarker et al[60]2014RetrospectiveUnited States8----100-1004 – 520.0
Mangiavillano et al[61]2016RetrospectiveItaly20--90---9012NR
Aiolfi et al[62]2014RetrospectiveItaly7---85.7--85.7NRNR
Manta et al[5]2013Case series Multi-centerItaly30-90----901 – 40.0
Mangiafico et al[63]2017Case series ProspectiveInternational77100-----1002 – 80.0
Niland et al[64]2017RetrospectiveUnited States1421.4-----21.4260.0
Schmdtt et al[4]2018Prospective RCTInternational833-84.8----84.840.0
Heinrich et al[65]2017Case series RetrospectiveSwitzerland5100-----10046 – 2690.0
Prosst et al[66]2015ProspectiveGermany2090-----90240.0
Mizrahi et al[67]2016ProspectiveUnited States5135.3757550-5049.048NR
Kirschniak et al[68]2011RetrospectiveGermany4637.593100---84.81 – 20.0
Mennigen et al[69]2015RetrospectiveGermany1070-----7022 – 750.0
Wedi et al[70]2016Retrospective Case seriesInternational96-100----100NRNR
Baron et al[71]2012Retrospective Multi-centerUnited States4367.91008033.3--72.14 – 112 (4.7)
Lamberts et al[72]2017RetrospectiveGermany75-65.3----65.3NRNR
Soetikno et al[73]2016Case series RetrospectiveInternational105-100----100600.0
Wedi et al[74]2017RetrospectiveInternational11100-86----73NRNR
Chan et al[75]2014Case series ProspectiveChina9-77.8----77.88NR
Keen et al[76]2019ProspectiveUnited Kingdom59-93.2----93.24NR
Horenkamp-Sonntag et al[77]2019RetrospectiveGermany92-82.487.9---92.414NR
Manta et al[78]2019Retrospective Multi-centerItaly286-94.4----94.44NR
Mercky et al[79]2015RetrospectiveFrance3073.3-----73.3423 (10)
Monkemuller et al[80]2014Case series RetrospectiveGermany1650100-010010075440.0
Bonino et al[81]2014Case series ProspectiveItaly2690-68.8---76.9NR0.0
Christophorou et al[82]2015Retrospective Multi-centerFrance1478.5-----78.5NRNR
Lunse et al[83]2019RetrospectiveGermany966.7-----66.780.0
Mosquera-Klinger et al[84]2019Retrospective Case seriesColumbia1470100100--10078.6200.0
Brander et al[25]2017RetrospectiveUnited States67-70.1----70.14NR
Meier et al[47]2017RetrospectiveGermany10----100-100120.0
Tashima et al[85]2017ProspectiveJapan50----94-9424 (8)
Khater et al[86]2017RetrospectiveFrance11--81.2---81.2NR1 (9)
Asokkumar et al[87]2018RetrospectiveInternational1219-100----100NR0.0
Morrell et al[88]2019RetrospectiveUnited States11750.8--75--61.2220.0
Kappelle et al[89]2018ProspectiveNetherlands13----84.6-84.6245 (38.4)
Wei et al[90]2019RetrospectiveChina26--100---10040.0
Golder et al[91]2019RetrospectiveGermany100-75----75NR0.0
Wedi et al[92]2018Retrospective Multi-centerGermany118-92.4----92.44NR
Total302555.8%86.0%85.3%72.6%92.8%80.0%78.4%-2.1%
347/6221120/1303399/468284/391205/22116/202371/3025-40/194213
1Germany, United States.
2France, Italy, India.
3Switzerland, Germany.
4Italy, United Kingdom.
5Germany, Japan.
6United States, Italy, Germany, Netherlands, Chile.
7Italy, United Kingdom.
8Germany, China, Switzerland.
9Germany, France, Canada, United States.
10United States, Singapore.
11Germany, France, Canada, United States.
12Singapore, Spain.
13Over the scope clip-related adverse events were only reported for 1958 of 3041 patients (n = 65 studies). NR: Not reported; ER: Endoscopic resection; RCT: Randomized control trial.
Full Size Table
Table 3 Over-the-scope clip-related adverse events, per-indication
Incorrect placement sitePerforationBleedingInfectionOverall
Fistula03025
Bleeding00000
Perforation222217
Leak11013
ER427619
Stent fixation00000
Total78910341
1The total number of Over the scope clip-related adverse events recorded was 40; however, one article (Honegger et al[41]) did not report adverse events per-indication and thus cannot be included in this table. A total of six such events occurred, including: incorrect placement site (n = 4), perforation (n = 1) and bleeding (n = 1);
2Adverse events for the initial indication of perforation are defined as exacerbation or worsening of the index perforation qualifying as a separate adverse event. ER: Endoscopic resection.
Full Size Table
Table 4 Per-indication clinical success rate, technical success rate, and post-over-the-scope clip surgery rates
Clinical success rate (%), (n/N)Technical success rate (%), (n/N)Post-over the scope clip surgical rate (%), (n/N)
Fistula55.8 (347/622)92.8 (577/622)7.6 (47/622)
Bleeding86.0 (1120/1303)96.8 (1261/1303)1.6 (21/1303)
Perforation85.3 (399/468)95.5 (447/468)9.4 (44/468)
Leak72.6 (284/391)86.7 (339/391)7.4 (29/391)
ER92.8 (205/221)95.9 (212/221)0.9 (2/221)
Stent fixation80.0 (16/20)100 (20/20)0.0 (0/20)
Overall78.4 (2371/3025)94.4 (2856/3025)4.7 (143/3025)
ER: Endoscopic resection.
Full Size Table
Table 5 Summary of prospective studies (overall clinical success rate, per-indication clinical success rate and adverse event rate)
Ref.
Year
Type of study
Country
Patients (n)
Overall clinical success rate (%)
Follow-up (wk)
Adverse events, n (%)
Indications
Total
FistulaBleedingPerforationLeakER3Stent fixation
Maekawa et al[21]2015ProspectiveJapan12----11/12-11/12NR0.0
Voermans et al[24]2012Prospective Multi-centerNetherlands36--32/36---32/261-260.0
Lee et al[26]2017Prospective Multi-centerKorea191/4-1/110/121/2-13/19720.0
Arezzo et al[28]2012Case series ProspectiveItaly14---12/14--12/14160.0
Schlag et al[29]2013ProspectiveGermany6--6/6---6/64-120.0
Gubler et al [31]2012Case series ProspectiveSwitzerland14--12/14---12/144-48NR
Singhal et al[32]2014Case series ProspectiveUnited States109/10-----9/1070.0
Schmidt et al[4]2015Prospective Multi-center RCTInternational124----18/24-18/2442 (8.3)
Correia et al[36]2014Case series ProspectivePortugal64/5-1/1---5/6NR0.0
Goenka et al[37]2017ProspectiveIndia122/36/63/3---11/124-80.0
Surace et al[38]2011ProspectiveItaly1914/19-----14/19321 (5.3)
Kochhar et al[39]2017Case series ProspectiveUnited States12---8/12--8/12601 (8.3)
Manta et al[40]2017ProspectiveItaly76---61/76--61/76NR0.0
Parodi et al[41]2010ProspectiveItaly104/5-3/31/2--8/10NR0.0
Sulz et al[52]2014Case series ProspectiveSwitzerland196/111/1-4/6-1/112/19NR0.0
Magdeburg et al[53]2015ProspectiveGermany43--42/43---42/43NR3 (7.0)
Keren et al[55]2014Case series ProspectiveIsrael26---21/26--21/26NR0.0
Hagel et al[57]2012Case series ProspectiveGermany17--11/17---11/174NR
Mangiafico et al[63]2017Case series ProspectiveInternational277/7-----7/72-80.0
Schmdtt et al[4]2018Prospective RCTInternational333-28/33----28/3340.0
Prosst et al[66]2015ProspectiveGermany2018/20-----18/20240.0
Mizrahi et al[67]2016ProspectiveUnited States516/173/43/412/24-1/225/5148NR
Chan et al [75]2014Case series ProspectiveChina9-7/9----7/98NR
Keen et al[76]2019ProspectiveUnited Kingdom59-55/59----55/594NR
Tashima et al[85]2017ProspectiveJapan50----47/50-47/5024 (8)
Kappelle et al[89]2018ProspectiveNetherlands13----11/13-11/13245 (38.4)
Total61770.3%89.3%89.1%75.0%87.1%66.7%81.7%-3.4%
71/101100/112114/128129/17288/1012/3504/617-16/4674
1Switzerland, Germany.
2Italy, United Kingdom.
3Germany, China, Switzerland.
4Over the scope clip-related adverse events were only reported for 467 of 617 patients (n = 21 studies). NR: Not reported; ER: Endoscopic resection; RCT: Randomized control trial.
Full Size Table
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