Endoscopic management for gastrointestinal leaks, perforations, and fistulae: Technical tips and outcomes

Table 3 Outcomes of through the scope clips and over the scope clips in the management of gastrointestinal tract defects

Ref.	Study design	Population characteristics	Outcomes in the clip cohort	Outcomes in control cohort	Additional information
Kirschniak et al[29], 2011	Retrospective	n = 50, GI Bleed: n = 27. Perforation: n = 11. Fistulae: n = 8. Pre-op marking: n = 4	Primary success: 100%. Recurrence of GI bleed: 2 (7.4%). Recurrence of fistulae: 5 (62.5%). No recurrence of perforation	NA	High recurrence of fistulae despite initial success
Hagel et al[34], 2012	Prospective	n = 17 (Iatrogenic perforations: n = 6. AL: n = 3. Complication of PEG: n = 5. Duodenal ulcer perforation: n = 3). Median age: 71 ± 7 years	Successful closure: 11 (64.7%)	NA	Six unsuccessful cases had larger perforation defects and had necrotic or soft inflammatory margins
Voermans et al[33], 2012	Prospective, multicenter	n = 36. Acute iatrogenic perforations. Location: Esophageal: n = 5. Gastric: n = 6. Duodenal: n = 12. Colonic: n = 13. M: 15; F: 21	Successful closure: 33 (92%). Clinical success: 32 (89%). Surgery: n = 4. Death: n = 1	NA	Death occurred in one patient with colonic perforation (even after surgery)
Lee et al[13], 2013	Retrospective	35 patients with AL after surgery for gastric cancer. M: n = 27, F: n = 8. Median age: 64 Y	n = 20. Technical clinical success: 19 (95%). Surgery due to failed endoscopic t/t: n = 1. Death: n = 0	n = 15. Death: n = 5. Cause of death: Sepsis, bleeding, HAP	Endoscopic modality: Hemoclips: n = 17. Detachable snare: n = 2. Additional fibrin glue: n = 14
Haito-Chavez et al[35], 2014	Multicenter, retrospective	n = 188. Fistulae: n = 108. Perforations: n = 48. AL: n = 32	Overall success: 60.2%. Success rate for perforations: 90%. Success rate for AL: 73.3%. Success rate for fistulae: 42.9%	NA	Success rate is significantly higher for acute defects (like perforations/AL) than for chronic defects (fistulae). Success rate is significantly higher if OTSC is applied for primary therapy (69.1%) than for rescue therapy (46.9%; P = 0.004)
Law et al[37], 2015	Retrospective	n = 47. Mean age: 57 ± 14. M: 24; F: 23. Fistula location: Esophagus: n = 3. Stomach: n = 16. Small bowel: n = 18. Colo-rectum: n = 10	Initial technical success: 42 (89%). Fistula recurrence: 25 (53%) at median f/u of 178 days	NA	Poor long-term outcomes of OTSC: Fistula recurrence around 50% despite OTSC retention
Verlaan et al[14], 2015	SRMA	24 studies; 21 retrospective, 3 prospective, no RCT. n = 466 Hemoclips: n = 398. OTSC: n = 66. Stents: n = 2	Successful outcome: 419 (89.9%). Success rate of hemoclips: 359 (90.2%). Success rate of OTSC: 58 (87.8%). Success rate of stents: 2 (100%)	NA	Limited by the low methodological quality of included studies
Kobara et al[39], 2019	SRMA	30 studies. n = 1517	Clinical success rate: For perforation: 85% (n = 351). For AL: 66% (n = 97). For fistulae: 52% (n = 388)	NA	Overall complications: 1.7% (n = 23). Severe complications: 0.59% (n = 9)

AL: Anastomotic leak; HAP: Hospital-acquired pneumonia; F: Female gender; F/u: Follow-up; M: Male gender; NA: Not available; OTSC: Over the scope clips; PEG: Percutaneous endoscopic gastrostomy; Pre-op: Pre-operative; RCT: Randomised control trial; SRMA: Systematic review and meta-analysis; t/t: Treatment.