# A38 OVER-THE-SCOPE AND THROUGH-THE-SCOPE SUTURING OUTCOMES FOR ENDOSCOPIC LEAK AND FISTULA MANAGEMENT: A SYSTEMATIC REVIEW

## TL;DR

This study reviews how well over-the-scope and through-the-scope suturing work for treating gastrointestinal leaks and fistulas, finding variable success rates.

## Contribution

The paper provides a systematic review comparing outcomes of OTSS and TTSS for managing leaks and fistulas, highlighting their success rates and limitations.

## Key findings

- Technical success for OTSS and TTSS in fistulae ranged from 83-100% and 82-100%, respectively.
- Clinical success for OTSS and TTSS in fistulae ranged from 0-80% and 55-100%, respectively.
- Technical success for OTSS in leaks ranged from 90-100%, while TTSS ranged from 0-57%.

## Abstract

Leaks and fistulae are well-recognized sequelae arising from gastrointestinal surgeries, inflammatory bowel disease, malignancy, and traumatic injury; reflecting significant morbidity, mortality and resource utilization. Endoscopic management has gained traction as a minimally invasive alternative to surgery including both over-the-scope suturing (OTSS) and through-the-scope suturing (TTSS).

We aimed to systematically evaluate available evidence for OTSS and TTSS outcomes for leak and fistula management.

From inception to July 1st, 2024, MEDLINE, EMBASE and Cochrane Library were searched for relevant citations. Full-text citations were included if they evaluated both technical success (endoscopic closure of leak or fistula) and clinical success (technical success with avoidance of further intervention) for leak or fistulae management with OTSS or TTSS. In this preliminary analysis, outcomes were reported as ranges.

A total of 11 studies including 185 defects were included for analysis. For fistulae, technical success for OTSS and TTSS ranged from 83-100% and 82-100%, respectively. Clinical success for OTSS and TTSS ranged from 0-80% and 55-100% respectively. For leaks, technical success for OTSS and TTSS ranged from 90-100% and 0-57%, respectively. Clinical success for OTSS and TTTS ranged from 25-100% and 29%, respectively.

OTSS and TTSS are new interventions for leak and fistulae management with varying performance outcomes. Further research is required to delineate optimal candidates for OTSS/TTSS closure and treatment algorithms after technical/clinical failure.

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