Abstract
Aims The over-the-scope clip (OTSC) has recently emerged as a new endoscopic device for treating gastrointestinal bleeding, perforations, fistulas, and leaks. A modified OTSC device (full-thickness resection device, FTRD) has been widely used for endoscopic full-thickness resection. However, there is less experience regarding the indications and methods for OTSC removal. We aimed to summarize the existing methods and indications for OTSC removal. Methods We searched PubMed, Cochrane Library, and ClinicalTrials.gov to identify relevant publications on OTSC removal. The details of OTSC removal, including the methods, indications, success rates, adverse events, and failure causes, were extracted and summarized. A meta-analysis of pooled success rates was conducted using STATA 15.0. Results Eighteen articles were included. The reported methods for OTSC removal included (1) grasping forceps, (2) the Nd : YAG laser, (3) argon plasma coagulation, (4) the remOVE system, (5) endoscopic mucosal resection/endoscopic submucosal dissection, and (6) ice-cold saline solution. Indications for OTSC removal were (1) poor healing, (2) OTSC misplacement, (3) repeat biopsy/therapy or further treatment, (4) adverse events after OTSC implantation, (5) removal after recovery, and (6) patient wishes. The pooled success rate of OTSC removal was 89% in patients treated with the remOVE system. Minor bleeding, superficial thermal damage, and superficial mucosal tears were common adverse events. Mucosal overgrowth was the main cause of OTSC removal failure. Conclusions The remOVE system is the best investigated method, with sufficient efficacy and safety for OTSC removal. This is the first systematic review of OTSC removal and provides significant guidance for clinical practice.
Highlights
Ying Hua Ou, Wei Fang Kong, Li Fu Li, Pei Sheng Chen, San Hua Deng, Feng Jian He, Qian Qian Peng, and Hui Yue
We conducted a comprehensive search of the PubMed, Cochrane Library, and ClinicalTrials.gov databases with the following key words: “over-the-scope clip,” “OTSC,” “Fullickness Resection Device,” “FTRD,” “remove,” and “follow up.” e last search was conducted on 20 January 2020
As the studies included in the meta-analysis were nonrandomized studies, the methodological index for nonrandomized studies (MINORS) was applied for quality assessment (Table 1) [11]. e statistical analyses were performed using STATA 15.1 and Office 365. e chisquared and I-squared tests were used to calculate the heterogeneity among the studies. e pooled rate and 95% confidence interval were calculated by a fixed model (I2 < 40%) or a random model (I2 > 40%). e results are presented as forest plots
Summary
We aimed to summarize the existing methods and indications for OTSC removal
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