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

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 being increasingly employed as a salvage approach; however, supporting evidence remains limited. Methods A retrospective analysis was performed on 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 regarding patient demographics, previous interventions, technical and clinical outcomes, and follow-up were evaluated. Results All six patients (mean age 39.7 ± 11.9 years; body mass index (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 (SEMS), internal drainage, and septotomy, with several individuals requiring multiple surgical sessions for lavage and drainage. OTSC placement was technically successful in all cases (100%), with clinical closure achieved in five out of six patients (83.3%) at a mean follow-up duration of 525.2 ± 413.9 days (range, 93–1221 days). One patient who did not achieve closure required additional endoscopic treatment and multiple subsequent surgical interventions. No adverse events or mortality were reported. Conclusion OTSC demonstrates safety and efficacy as a rescue modality for persistent post-bariatric leaks refractory to conventional endoscopic management, offering high rates of technical success and sustained clinical benefit.