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Introduction: There are few options available for treatment of fistulas, leaks, and perforations endoscopically. Here we describe our experience with a new endoscopic clipping system.

Methods: A retrospective review of all cases using the Over-The-Scope-Clip system (Ovesco Endoscopy AG, Tuebingen, Germany) between August 2011 and November 2011. Resolution of leak was determined by a swallow study or CT scan.

Results: The system was utilized in ten patients with clinically significant gastrointestinal surgical complications. Three patients were referred for treatment of gastric leaks following a sleeve gastrectomy, two had post-operative colonic leaks, two had gastro-gastric fistulas following roux-en-y gastric bypass, and three had esophageal perforations. All three gastric leaks occurred just distal to the GE junction and each had undergone previous attempts at treatment with other endoscopic methods. The average number of over the scope clips placed in these three patients was 2. In two patients there was complete resolution of the leak, one requiring a second clip placement. The third patient had a contained leak following clip placement that was followed clinically, follow up swallow study at six days showed improvement, and she was discharged home. Two patients had gastro-gastric fistulas following roux-en-y gastric bypass surgery. One of these patients had complete resolution of the fistula. The other had initial success but the clip displaced and fistula recurred. Two patients presented with anastomotic leak following colon resection. In one case the patient had extensive adhesions resulting in a rigid colon and the Ovesco system on a pediatric scope was too large to reach the fistula, so the procedure was aborted. In the second case, the leak was successfully treated with a single clip. Three patients were successfully treated for esophageal perforation. One had a 9 mm mid-esophageal perforation that required staged placement of two clips. One had two separate distal esophageal perforation sites, each requiring one clip. The final esophageal perforation was treated with a single clip. The average operative time for clip placement was 61 minutes. There were no complications.

Conclusions: This over the scope endoscopic clip system is simple to use, safe, and successful in approximating tissue to treat traditionally difficult surgical complications. There is a potential for broad applications of this new technology. Further experience and longer follow up are needed to assess its indications as related to defect size and location.