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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

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Abstract

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.

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Acknowledgements

We would like to extend our appreciation to Anabela Rodrigues for her efforts in the preparation of this manuscript.

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Authors and Affiliations

  1. Bariatric and Metabolic Institute, Department of Surgery, The Brooklyn Hospital Center, Icahn School of Medicine at Mount Sinai, Brooklyn, NY, USA

    Saeed Shoar, Lauren Poliakin, Jun L. Levin & Alan A. Saber

  2. Department of Surgery, School of Community Medicine, University of Oklahoma at Tulsa, Tulsa, OK, USA

    Zhamak Khorgami

  3. St. George’s University School of Medicine, St. George’s, Grenada

    Rebecca Rubenstein

  4. Department of Surgery, Hamad Medical Corporation, Qatar Weill Cornell Medicine, Doha, Qatar

    Moamena El-Matbouly

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  1. Saeed Shoar
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Correspondence to Alan A. Saber.

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Shoar, S., Poliakin, L., Khorgami, Z. et al. 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. OBES SURG 27, 2410–2418 (2017). https://doi.org/10.1007/s11695-017-2651-4

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