Efficacy and safety of over-the-scope clips (OTSC®) for closure of gastrointestinal fistulas less than 2 cm

Background and aim Gastrointestinal (GI) fistula is a complication of surgery associated with potential morbidity and mortality. The aim of this study was to evaluate the efficacy and safety of over-the-scope clips (OTSC (R)) for closing GI fistulas. Methods Patients with GI fistula who underwent endoscopic closure using OTSC (R) were enrolled. The clinical date, duration, location and diameter of the fistula, technical success of the OTSC (R), complications, follow-up periods and clinical success were recorded. Results A total of 98 patients with GI fistula underwent OTSC (R) closure. Their median age was 50 years (range 16-88 years), and the median duration of the fistula was 185.5 days (range 12-3129 days). The mean diameter of fistula was 4.64 +/- 1.16 mm. Technical success was achieved in 100% of the patients, and clinical success was achieved in 55.10% (54/98) of the patients after a median follow-up of 168.5 days (range 36-424 days). Based on the location of the fistula, the clinical success rate of treating a fistula in the esophagus and small intestine was 100%, followed by the rectum (70%, 7/10), anastomotic stoma (61.90%, 13/21), duodenum (53.33%, 8/15), colon (47.06%, 8/17), stomach (43.47%, 10/23) and appendix stump (33.33%, 2/6). The duration of the fistula (HR 3.609, 95% CI 1.387-9.387, P = 0.009) was a risk factor for clinical success by multivariate analysis. Conclusion OTSC (R) is a safe and efficient treatment for GI fistula and is a potential alternative to the surgical approach. Before OTSC (R) placement, the duration of the fistula should be assessed since it is related to the successful closures with OTSC (R).

Automated summary

This study evaluated the efficacy and safety of using over-the-scope clips (OTSC(R)) for closing gastrointestinal (GI) fistulas. The results showed that OTSC(R) is a safe and efficient treatment for GI fistulas, with the duration of the fistula being an important factor for successful closure.