Clin Endosc.  2021 Nov;54(6):798-804. 10.5946/ce.2021.250.

Over-the-Scope Clip in the Treatment of Gastrointestinal Leaks and Perforations

• Wei MT
• Ahn JY
• Friedland S

• KMID: 2522698
• DOI: http://doi.org/10.5946/ce.2021.250

Abstract

While perforations, postoperative fistulas, and leaks have traditionally led to surgical or interventional radiology consultation for management, the introduction of the over-the-scope clip has allowed increased therapeutic possibilities for endoscopists. While primarily limited to case reports and series, the over-the-scope clip successfully manages gastrointestinal bleeding, perforations, as well as postoperative leaks and fistulas. Retrospective studies have demonstrated a relatively high success rate and a low complication rate. Given the similarity to variceal banding equipment, the learning curve with the over-the-scope clip is rapid. However, given the higher risk of procedures involving the use of the over-the-scope clip, it is essential to obtain the scope in a stable position and grasp sufficient tissue with the cap using a grasping tool and/or suction. From our experience, while closure may be successful in lesions sized up to 3 cm, successful outcomes are obtained for lesions sized <1 cm. Ultimately, given the limited available data, prospective randomized trials are needed to better evaluate the utility of the over-the-scope clip in various clinical scenarios, including fistula and perforation management.

Keyword

Fistula; Gastrointestinal leak; Over-the-scope clip; Ovesco; Perforation

Figure

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  Fig. 1. Over-the-scope clip (OTSC) loaded on a therapeutic upper endoscope. The tip of the endoscope is attached to a cap loaded with the OTSC, and the biopsy channel is loaded with the hand wheel.

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  Fig. 2. Over-the-scope clip types. (A) Type gc. (B) Type t. (C) Type a.

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  Fig. 3. Use of over-the-scope clip in the closure of percutaneous endoscopic gastrostomy tube site.

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