OTSC System, OTSC Clips

Systematic review: leaks and fistulae after laparoscopic sleeve gastrectomy successfully c…

A systematic literature review evaluating efficacy and safety of the OTSC System in the management of leak and fistula after laparoscopic sleeve gastrectomy (LSG) was published by Shoar S et al., Bariatric and Metabolic Institute, department of surgery, The Brooklyn Hospital Center, Icahn School of Medicine at Mount Sinai, Brooklyn, NY, USA.

A total of 10 eligible studies including 195 patients with post-LSG leaks/fistulae were identified. The time interval between LSG and leak/fistula ranged from 1 day to 803 days. Most of the leaks/fistulae were located at the proximal staple line, and had a size from 3 to 20 mm. Time between leak diagnosis and OTSC clipping ranged from 0 to 271 days.

Details for endoscopic management of post-LSG leak/fistula by OTSC were available for nine studies (73 patients). Of the 73 patients with post-LSG leak treated with OTSC, 63 patients had an overall successful closure (86.3 %). Number of the deployed OTSC was reported by six studies (53 patients). Of these, 33/53 patients (63.5 %) required one clip for closure of the lesion, 14 patients (36.9 %) required one or more clips and 5 patients (9.6 %) required two clips.

Regarding OTSC-related complications, OTSC migration was reported in one patient (1.4 %), stenosis in one patient (1.4 %), and tear in one patient (1.4 %).

In conclusion, the authors stated that the OTSC System is a promising endoscopic approach for management of post-LSG leaks in appropriately selected patients. Unfortunately, most studies are series with a small sample size, short-term follow-up, and mixed data of concomitant procedures with OTSC. Further studies should distinguish the net efficacy of the OTSC system from other concomitant procedures in treatment of post-LSG leak.

Efficacy and Safety of the Over-the-Scope Clip (OTSC) System in the Management of Leak and Fistula After Laparoscopic Sleeve Gastrectomy: a Systematic Review.
Shoar S, Poliakin L, Khorgami Z, Rubenstein R, El-Matbouly M, Levin JL, Saber AA (2017)
Obes Surg 2017 Sep;27(9):2410-2418.