title: 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.
abstract: Endoscopic management of leaks/fistulas after laparoscopic sleeve gastrectomy (LSG) is gaining popularity in the bariatric surgery.
  
  
  
  This study aimed to review the efficacy and safety of over-the-scope-clip (OTSC) system in endoscopic closure of post-LSG leak/fistula.
  
  
  
  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.
  
  
  
  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%).
  
  
  
  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.
authors.affiliation: Bariatric and Metabolic Institute, Department of Surgery, The Brooklyn Hospital Center, Icahn School of Medicine at Mount Sinai, Brooklyn, NY, USA.
authors.forename: Saeed
authors.initials: S
authors.lastname: Shoar
authors.affiliation: Bariatric and Metabolic Institute, Department of Surgery, The Brooklyn Hospital Center, Icahn School of Medicine at Mount Sinai, Brooklyn, NY, USA.
authors.forename: Lauren
authors.initials: L
authors.lastname: Poliakin
authors.affiliation: Department of Surgery, School of Community Medicine, University of Oklahoma at Tulsa, Tulsa, OK, USA.
authors.forename: Zhamak
authors.initials: Z
authors.lastname: Khorgami
authors.affiliation: St. George's University School of Medicine, St. George's, Grenada.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Rubenstein
authors.affiliation: Department of Surgery, Hamad Medical Corporation, Qatar Weill Cornell Medicine, Doha, Qatar.
authors.forename: Moamena
authors.initials: M
authors.lastname: El-Matbouly
authors.affiliation: Bariatric and Metabolic Institute, Department of Surgery, The Brooklyn Hospital Center, Icahn School of Medicine at Mount Sinai, Brooklyn, NY, USA.
authors.forename: Jun L
authors.initials: JL
authors.lastname: Levin
authors.affiliation: Bariatric and Metabolic Institute, Department of Surgery, The Brooklyn Hospital Center, Icahn School of Medicine at Mount Sinai, Brooklyn, NY, USA. saber6231@gmail.com.
authors.forename: Alan A
authors.initials: AA
authors.lastname: Saber
mesh_terms: D057868:Anastomotic Leak / Q000209:etiology / Q000601:surgery; D050110:Bariatric Surgery / Q000009:adverse effects; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data; D005743:Gastrectomy / Q000009:adverse effects*; D005747:Gastric Fistula / Q000209:etiology / Q000601:surgery; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*
keywords: Endoscopic clipping; Fistula; Laparoscopic sleeve gastrectomy; Leak; OTSC; Over the scope clip