Table 3.
Clipping in the management of post-bariatric leak/fistula—characteristics of leak/fistula and endoscopic procedures
| Study | Localization (n) | Size (mm) | Clip type (size) | Success and failure | Complications of clipping | Follow-up (time and imaging) |
|---|---|---|---|---|---|---|
| Tabibian/2017 | Gastric pouch | NA | OTSC (12/6t) | Yes | – |
2 days (swallow test) and 4 months Stable body mass, no symptoms |
| Callabero/2016 | Proximal staple line | 5 | OTSC (12/6t-10 mm) | Yes | – |
6 months (endoscopy), 12 months (examination/endoscopy) After 1 year asymptomatic, weight loss remained above 75% |
| Donatelli/2014 | Gastrogastric | NA | 1 OTSC (14/6t) | Yes | – |
30 days (UGI series) Weight loss |
| Aly/2013 |
GEJ (1) GEJ (1) |
NA | OTSC (12/6t) | Yes | – |
1 case—2 weeks (endoscopy) 8 months; 2 case—6 months (blue dye test) |
| Ritter/2013 |
Gastrojejunal anast. (1) Gastrogastric (1) |
NA | 2 Endoclips | Yes | – | 14 days (UGI series) |
| Iacopini/2010 | GEJ (2 fistulas) | NA | OTSC and OTSC + stent | Yes | 24 h (barium swallow), 8 weeks (barium swallow) | |
| Merrifield/2006 | Gastrogastric and Gastroperitoneal | NA |
1 TriClip + 4 Qucik Clip |
Failure after 20 days: 2TriClips + APC At 6 weeks: closure of peritoneal fistula, persistence of small gastrogastric (PPI) |
20 days and 6 weeks (endoscopy, UGI series) 1 year—clinical assessment |
|
| Lee/2018 | Anastomotic esophagogastrostomy site | 5–10 | OTSC |
Technical success: 3/3 Final success: 2/3 Failure: 1/3 |
None | 750–840 days |
| Benosman/2018 | Proximal staple line | 8.3 (± 4.6) | OTSC | Success of OTCS alone: 7/7 |
None related to OTSC Complications related only to stent placement |
Mean follow-up: 122 days (± 72) Every 3–4 weeks endoscopy Recurrence diagnosis with CT scan and endoscopy |
| Kim/2017 | Posteroinferior site | OTSC |
Success of OTCS: 0/1 Further treatment: SEMS and surgery |
None | UGI contrast series | |
| Niland/2017 | Gastrogastric | 3–15 |
OTSC (Multiple attempts with OTSC in 3 patients) |
Technical success: 12/14 Lost of follow-up: 4/14 Primary success (normal UGI series/subsequent endoscopy): 5/10 Long term success (status on recent imaging): 3/4 (mean 6.6 months) |
None | Mean: 6.6 months (UGI series and/or endoscopy) |
| Keren/2015 |
GEJ (18) Antral (1) |
NA |
1 OTSC (21) 2 OTSC (5) |
Success (since clip till full oral diet initiated, range: 14–60 days): OTCS: 17/19 Failure OTCS: 2/19 |
– | Endoscopy |
| Law/2015 | Gastrogastric | NA |
OTSC (12/6GC: 6 12/6 T: 4, 11/6 T: 1) |
Immediate clinical success: 6 (75%) Need for repeated intervention: 5 (63%) Delayed clinical success (after 8 weeks): 4 (50%) |
NA |
Median follow-up: 178 days (IQR: 63–326) Suspicion of recurrent fistula: endoscopy, radiologic imaging |
| Moon/2015 | GEJ | NA | Hemoclips | Yes | NA | NA |
| Mercky/2014 |
Esophagogastric (14) Gastrocutaneous (3) Gastrogastric (1) Esophagobronchial (1) Enterocutaneous (1) |
3–15 | OTSC |
Primary success (technical and clinical after first procedure): OTSC: 9/15; OTSC + SEMS: 2/4 Secondary success (with additional treatment after initial OTSC failure): OTSC: 4/15; OTSC + SEMS:1/4 Failure: OTCS: 2/15; OTSC + SEMS: 1/4 |
Anchor migration (1), fistula edges lorn by anchor (1), mediogastric stenosis caused by OTSC (1) | NA |
| Surace/2011 |
SG: gastric GB: gastrogastric |
NA | OTSC |
Primary success after SG: 6 (54.5%) (in 1 case with 2 OTSC) Secondary success after SG: 4 (36.5%) Failure: 1 case after SG, 1 case after GB |
1 complication related to delivery system (the anchor blocked within the clip) | Mean follow-up: 8 months |
| Bhardway/2010 | < 20 mm | 3–6 Resolution clips |
Early failure (after 2 weeks): 2 Delayed failures (after several weeks): 2 Further treatment in failures: surgical repair |
None | At 2 weeks: UGI series Maximum follow-up: 8–46 months |
N number, GEJ gastroesophageal junction, SG sleeve gastrectomy, GB gastric bypass, OTSC over-the-scope clip, SEMS self-expandable metal stents, APC argon plasma coagulation, PPI proton pump inhibitor therapy, UGI upper gastrointestinal imaging, NA data not available