Natural History and Retention Time of Over-the-Scope Clips in Clinical Practice

Background and Aims: Over-the-scope clips (OTSCs; Ovesco Endoscopy) have been used for closure of fistulas, leaks, acute perforations, gastrointestinal tract bleeding, and stent anchoring. Adverse events (AEs) include perforation, migration, and ulceration. Little is known about the natural history of OTSCs, and no data addressing the longevity of OTSCs are available. We reviewed our center's experience with the natural history of the OTSC device. Methods: We retrospectively identified patients who had OTSCs placed from 2011 through 2018 at our institution. The primary end point was clinical success. Secondary outcomes included clip retention time, clinical success based on clip retention time, AEs after OTSC placement, and factors that might influence the development of AEs or affect OTSC retention. Results: Among 430 patients (62.6% men; mean [SD] age, 63 [16] years), 489 OTSCs were placed. Clip placement was clinically successful in 373 cases (76.3%). Median time to clip loss was 442 (95% CI, 368-480) days. AEs occurred in 28 clip placements (5.7%) and included bleeding (n = 15), perforation (n = 2), and ulceration (n = 7). On univariate analysis, clips placed in the rectum were more likely to be lost (hazard ratio, 1.78; 95% CI, 1.06-3.03; P = 0.046). Clips placed for fistula closure (vs all other indications) were 81% more likely to be lost (hazard ratio, 1.81; 95% CI, 1.41-2.33; P < 0.001). Conclusion: OTSCs are retained for a median of 14.5 months, with clip location and placement indication being key factors in time to loss. These data can help guide decision-making when considering OTSC use across clinical indications.