Journal Article

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

Saber, Alan A., Rubenstein, Rebecca, Poliakin, Lauren, Levin, Jun L., El-Matbouly, Moamena, Shoar, Saeed, Khorgami, Zhamak

2017

Overview

Background Endoscopic management of leaks/fistulas after laparoscopic sleeve gastrectomy (LSG) is gaining popularity in the bariatric surgery. Objectives This study aimed to review the efficacy and safety of over-the-scope-clip (OTSC) system in endoscopic closure of post-LSG leak/fistula. Methods PubMed/Medline and major journals of the field were systematically reviewed for studies on endoscopic closure of post-LSG leaks/fistula by means of the OTSC system. Results A total of ten eligible studies including 195 patients with post-LSG leaks/fistula were identified. The time between LSG and leak/fistula ranged from 1 day to 803 days. Most of the leaks/fistula were located at the proximal staple line, and they sized from 3 to 20 mm. Time between leak diagnosis and OTSC clipping ranged from 0 to 271 days. Thirty-three out of 53 patients (63.5%) required one clip for closure of the lesion. Regarding the OTSC-related complications, a leak occurred in five patients (9.3%) and OTSC migration, stenosis, and tear each in one patient (1.8%). Of the 73 patients with post-LSG leak treated with OTSC, 63 patients had an overall successful closure (86.3%). Conclusion 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.

• Publisher: Springer US,Springer Nature B.V
• Subject: Anastomotic Leak - etiology / Anastomotic Leak - surgery / Bariatric Surgery - adverse effects / Digestive System Surgical Procedures - adverse effects / Digestive System Surgical Procedures - instrumentation / Digestive System Surgical Procedures - methods / Digestive System Surgical Procedures - statistics & numerical data / Endoscopy / Gastrectomy - adverse effects / Gastric Fistula - etiology / Gastric Fistula - surgery / Gastrointestinal surgery / Humans / Laparoscopy / Laparoscopy - adverse effects / Medicine / Medicine & Public Health / Obesity / Original Contributions / Surgery / Surgical outcomes