We also reviewed the references of the identified articles to acquire further studies that were not published in the databases mentioned above. We conducted a comprehensive search of the PubMed, Cochrane Library, and databases with the following key words: “over-the-scope clip,” “OTSC,” “Full-Thickness Resection Device,” “FTRD,” “remove,” and “follow up.” The last search was conducted on 20 January 2020. Hence, the purpose of this systematic review was to comprehensively summarize the indications for OTSC removal and to assess the experience gained with OTSC removal in terms of the success rates, failure causes, and adverse events of each method. However, there are neither guidelines nor a consensus concerning the indications or methods for OTSC removal. Some patients have even suffered psychosomatic abdominal pain due to awareness of the clips. These cases included OTSC misplacement or adverse events, such as ulcers and stenosis of the digestive tract. In some rare cases, OTSC removal might be desirable. Unlike normal titanium clips, it is more difficult for the OTSC to spontaneously detach from the mucosa. As a result, the safety of long-term OTSC retention inside the human body has not been well illuminated. However, those trials were conducted with either a small sample size or a short follow-up period. Over the past decade, the safety and efficacy of the OTSC in endoscopic treatments have been proven by many clinical trials. Recently, a new over-the-scope system, the full-thickness resection device (FTRD, Ovesco Endoscopy AG, Tuebingen, Germany), which consists of a modified OTSC, a polypectomy snare, and grasping forceps, has been widely used for endoscopic full-thickness resection. The OTSC has also been applied to close wounds after endoscopic full-thickness resection and to anchor esophageal self-expandable metallic stents. The over-the-scope clip (OTSC, Ovesco Endoscopy AG, Tuebingen, Germany) is an innovative endoscopic treatment device that presents several advantages, such as having a powerful clamping ability and a broader range for the closure of gastrointestinal bleeding sites, leaks, and fistulas. This is the first systematic review of OTSC removal and provides significant guidance for clinical practice. The remOVE system is the best investigated method, with sufficient efficacy and safety for OTSC removal. Mucosal overgrowth was the main cause of OTSC removal failure. Minor bleeding, superficial thermal damage, and superficial mucosal tears were common adverse events. The pooled success rate of OTSC removal was 89% in patients treated with the remOVE system. 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 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. A meta-analysis of pooled success rates was conducted using STATA 15.0. The details of OTSC removal, including the methods, indications, success rates, adverse events, and failure causes, were extracted and summarized. We searched PubMed, Cochrane Library, and to identify relevant publications on OTSC removal. We aimed to summarize the existing methods and indications for OTSC removal. However, there is less experience regarding the indications and methods for OTSC removal. A modified OTSC device (full-thickness resection device, FTRD) has been widely used for endoscopic full-thickness resection.

The over-the-scope clip (OTSC) has recently emerged as a new endoscopic device for treating gastrointestinal bleeding, perforations, fistulas, and leaks.

Iclip technique