Outcomes, effectiveness and safety of endoscopy over-the-scope clip placement in various gastrointestinal indications

Abstract

Background and Aims: In the last years, the over-the-scope clip (OTSC) has emerged as a first-line and rescue therapy in gastrointestinal (GI) non-variceal bleeding, perforations, fistulas, and leaks. Recently, OTCS has been used to minimize esophageal stent migration. This study aims to evaluate OTSC outcomes in several GI indications. Methods: We retrospectively collected data from all patients who underwent OTSC endoscopic placement at a tertiary center between 2013 and 2023. Results: Seventy-five patients were included, with 97 OTSCs being placed. The indications for OTSC were leaks and fistulas (both 35.2%), followed by acute perforations (21.2%) and GI bleeding (8.4%). Twenty-four patients had OTSC for stent fixation (32%), One OTSC was placed in 77% of the patients, with the remaining placing 2 or more. OTSC was the first endoscopic technique applied in 70.7% of the patients and 48% of patients needed multimodality treatment. Technical success of 1st and 2nd OTSC was 97.3% and 87.5%, respectively. Clinical success of 1st OTSC was 61.3%, increasing to 68% if considering OTSC global success. In the univariate analysis, clinical success was associated with smaller defects, defect location other than the esophagus, defect being a perforation or fistula, non-surgical related defect, absence of multimodality treatment and absence of associated collections. Only defect size and absence of multimodality treatment remained significant in the multivariate analysis. Conclusions: OTSC system is a safe and effective endoscopic therapy to manage GI bleeding and transmural defects, as well stent fixation. Larger defects and need for multimodality treatment are associated with higher chances of failure.