Published online Jun 28, 2020. doi: 10.3748/wjg.v26.i24.3495
Peer-review started: February 14, 2020
First decision: April 22, 2020
Revised: May 19, 2020
Accepted: May 30, 2020
Article in press: May 30, 2020
Published online: June 28, 2020
The over-the-scope-clip (OTSC) device has become widely utilized in endoscopic practice. Limited data exist evaluating the overall clinical success and adverse event (AE) rates of OTSC across gastrointestinal (GI) indications.
The key significance of this systematic review is to provide endoscopists with a real-world estimate of the efficacy and safety of OTSC in clinical practice.
The aim of this study was to determine the rates of clinical success (CSR), technical success (TSR), AE and post-OTSC (salvage) surgery rates.
A PubMed search was conducted for eligible articles describing the use of OTSC for any GI indication. Any article or case series reporting data for less than 5 total patients was excluded. Articles were included from January 1, 2007 to January 15, 2020. The following terms were used to perform the literature search: “over-the-scope-clip”, “OTSC”, “endoscopic fistula closure,” “over-the-scope clip bleeding”, “stent fixation”, and “endoscopic perforation closure.”
Eighty-five articles met inclusion criteria (n = 3025 patients). The overall CSR (inclusive of all indications) and TSR for OTSC placement was 78.4% (n = 2371/3025) and 94.4% (n = 2856/3025), respectively.
OTSCs are a novel advancement in endoscopic practice. They are safe and effective for use in GI hemorrhage, anastomotic leak, perforation, defects created by endoscopic resection and stent fixation; however, there is room for improvement in use for fistula closure.
Future large randomized control trials comparing OTSC with conventional and/or surgical interventions are needed to develop clinical guidelines for the most appropriate endoscopic application(s).