# Over-the-Scope Clip for Treating Chronic Bariatric Surgery Leaks Refractory to Prior Endoscopic Therapies: Experience From a Bariatric Center of Excellence

## TL;DR

This study shows that the over-the-scope clip (OTSC) is a safe and effective treatment for chronic bariatric surgery leaks that don't respond to other endoscopic methods.

## Contribution

The study provides real-world evidence supporting the use of OTSC as a salvage therapy for refractory bariatric leaks.

## Key findings

- OTSC placement was technically successful in all six patients.
- Five out of six patients achieved durable clinical closure of their leaks.
- No adverse events or mortality were observed during follow-up.

## Abstract

Background

Chronic leaks following bariatric surgery continue to present significant therapeutic challenges, particularly when conventional endoscopic interventions are unsuccessful. The over-the-scope clip (OTSC) is increasingly being employed as a salvage approach; however, supporting evidence remains limited. This study sought to assess the efficacy of the OTSC in complex cases in which conventional endoscopic interventions proved unsuccessful. We reviewed all refractory cases and proposed the use of the clip as an innovative strategy for these situations.

Methods

We performed a retrospective analysis of six consecutive patients with chronic post-bariatric leaks unresponsive to standard endoscopic therapy who underwent OTSC placement at our center of excellence between May 2022 and October 2025. Data on patient demographics, prior interventions, technical and clinical outcomes, and follow-up were collected and analyzed.

Results

All six patients (mean age 39.7 ± 11.9 years; BMI 44.0 ± 5.2 kg/m²; three males, three females) had previously undergone either primary or revisional bariatric procedures. Prior endoscopic interventions included fully covered self-expandable metallic stents, internal drainage, and septotomy, with several patients requiring multiple surgical sessions for lavage and drainage. OTSC placement was technically successful in all cases (100%), with clinical closure achieved in five of six patients (83.3%) over a mean follow-up of 525.2 ± 413.9 days (range, 93-1221 days). One patient who did not achieve closure required additional endoscopic therapy and multiple subsequent surgical interventions. No adverse events or mortality were reported.

Conclusions

OTSC placement is a feasible and effective salvage therapy for chronic bariatric surgery leaks refractory to conventional endoscopic approaches. Our findings show high technical success and favorable clinical outcomes, with most patients achieving durable leak closure and no significant adverse events. The absence of complications or mortality further supports the safety profile of this approach in carefully selected patients. In the interim, OTSC should be considered a valuable tool in the multidisciplinary management of refractory post-bariatric leaks, offering the potential for improved outcomes in this complex patient population.