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The Clinical Utility of Over the Scope Clip in the Treatment of Gastrointestinal Defects
Ido Mizrahi*1, Rana Eltawil3, Nadav Haim1, Sami Chadi1, Bo Shen2, Tolga Erim3, Steven Wexner1
1Colorectal Surgery, Cleveland Clinic Florida, Weston, FL; 2Gastroenterology, Cleveland Clinic, Cleveland, OH; 3Gastroenterology, Cleveland Clinic Florida, Weston, FL
Background: The Over the Scope Clip (OTSC) is an endoscopic tool that enables endoscopic management of patients with gastrointestinal (GI) luminal wall defects. The aim of this study was to report our experience with OTSC and to analyze its success rate in the management of patient with GI defects.
Methods: A prospectively maintained IRB-approved institutional database was queried for all patients treated with OTSC from 2012 to 2015. Primary outcome was the clinical success of the OTSC in treating the specific defect. Secondary outcome was the number of additional surgical and non-surgical procedures needed after an OTSC attempt.
Results: A total of 51 patients with a mean age of 55 years (55% female, mean BMI: 28kg/m2) were treated with the OTSC: 30 patients with an upper GI (UGI) defect and 21 with a lower GI (LGI) defect. Median follow up was 6 (range 1-29) months. Table 1 demonstrates the various indications for OTSC in our series: management of leak (n=24; UGI=12, LGI=12) and fistula (n=17; UGI=8, LGI=9) were the most common indications. Success rates for the treatment of leaks were 66% and 33% for UGI and LGI, respectively. Lower success rates were observed for the treatment of fistulae: 62% and 0% for UGI and LGI, respectively. Moderate success rates were observed in the treatment of UGI perforation, bleeding, and stent anchoring indications with success rates of 75%, 75%, and 50%, respectively. For the entire cohort, additional endoscopic or surgical interventions after application of the OTSC were indicated in 75% of patients with leaks, 70% of patients with fistulae, and 50% of patients with perforation, bleeding, or stent anchoring. Of note, additional surgery was required in 50% of patients with fistulae and 25% of patients with leak, perforation, and bleeding.
Conclusions: The OTSC appears to have an additional value in treating UGI defects. However, lower success rates for LGI defects were noted, specifically for the treatment of fistulae. The majority of patients require one or more additional endoscopic or surgical procedure after one OTSC attempt. Further prospective large cohort studies are needed to validate this novel endoscopic tool.
Table 1: Stratified demographics and results of upper and lower gastrointestinal indications for Over the Scope Clip placement.
| Indication | Leak (n=24) | Fistula (n=17) | Perforation (n=4) | Bleeding (n=4) | Stent Anchoring (n=2) | | Age (mean ± SEM) | 49±3.5 | 54±4.5 | 77±8 | 64±8 | 64±11 | | Female, n (%) | 11(45) | 10(59) | 3(75) | 3(75) | 1(50) | | BMI (Mean ± SEM) | 30±2 | 26±1 | 20±2 | 33±8 | 24±2 | | Lower GI Tract, n (%) | 12(50) | 9(53) | 0(0) | 0(0) | 0(0) | | Upper GI Tract, n (%) | 12(50) | 8(47) | 4(100) | 4(100) | 2(100) | Success, n (%)
Lower GI Tract, n (%)
Upper GI Tract, n (%) | 4(33)
8(66) | 0(0)
5(62) | NA
3(75) | NA
3(75) | NA
1(50) | | Patients needing additional procedures, n (%) | 18(75) | 12(70) | 2(50) | 2(50) | 1(50) | | Follow up (Months), Median (Range) | 7.5(1-25) | 7.5(1-29) | 0.5(1-3) | 12(1-21) | 1 |
SEM=standard error of mean; BMI=body mass index; GI=gastrointestinal; OTSC=Over the Scope Clip
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