Long-term outcomes of over-the-scope clip for refractory gastrointestinal diseases

Goda, Yasuhiro; Kobara, Hideki; Kobayashi, Nobuya; Nishiyama, Noriko; Fujihara, Shintaro; Tada, Naoya; Kozuka, Kazuhiro; Matsui, Takanori; Chiyo, Taiga; Shi, Tingting; Fujita, Koji; Tani, Joji; Yachida, Tatsuo; Takata, Masafumi; Okano, Keiichi; Nakano, Daisuke; Nishiyama, Akira; Mori, Hideki; Masaki, Tsutomu

doi:10.1080/13645706.2020.1867584

Cited by 6 publications

(7 citation statements)

References 25 publications

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“…The OTSC was confirmed to be smoothly discharged from the body through X-ray, and there were no complications. Consistent with the previous reports, long-term OTSC attachment can be safe and effective, regardless of spontaneous detachment ( 21 , 48 ).…”

Section: Discussionsupporting

confidence: 91%

Over-the-Scope Clip Applications as First-Line Therapy in the Treatment of Upper Non-variceal Gastrointestinal Bleeding, Perforations, and Fistulas

Qiu

Zhang

et al. 2022

Front. Med.

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BackgroundThe over-the-scope clip (OTSC) is an innovative device and has been successfully used in endoscopic treatment, however, there is a lack of clinical data from China. The aim of this study is to investigate the OTSC applications in the treatment of upper non-variceal gastrointestinal bleeding (UNVGIB), perforations, and fistulas in China.MethodsIn total, 80 patients were treated with one OTSC respectively as first-line therapy in our endoscopy center between January 2016 and November 2020. Among them, 41 patients had UNVGIB, 34 patients had perforations, and five patients had fistulas. The technical and clinical success rates were used to assess the efficacy of OTSC on the above diseases. In addition, we compared the hemostatic efficacy of OTSC with the standard endoscopic therapy in ulcer bleeding and Dieulafoy's lesion by propensity score matching analysis.ResultsIn general, the OTSCs were applied successfully in all patients and achieved 100% (80/80) technical success. The clinical success of all patients was 91.3% (73/80). Among 41 patients with UNVGIB, the clinical success was 85.4% (35/41); 6 patients presented with recurrence. For patients of Dieulafoy's lesion and under antithrombotic therapy, we found that OTSC treatment had both efficient and reliable hemostasis effects. In addition, according to the characteristics of ulcers, site of bleeding lesion, and Blatchford score, all patients received similar and reliable clinical success rates. After propensity score matching, we found that OTSC treatment had low rebleeding rates when compared with standard endoscopic therapy in both Dieulafoy's lesion (15.0 vs 30.0%) and ulcer bleeding (17.6 vs 29.4%). Among 34 patients with perforations, the clinical success was 100% (34/34). Among five patients with fistulas, only one patient failed in maintaining the OTSC before esophageal fistula healing, and the clip achieved an overall clinical success of 80% (4/5).ConclusionThe OTSC represents a safe and effective endoscopic therapy for UNVGIB, perforations, and fistulas as first-line treatment, especially for Dieulafoy's lesion or patients under antithrombotic therapy for UNVGIB, etc. However, OTSC application in these specific lesions or patients lacks adequate evidence as first-line treatment. Therefore, further larger sample and multi-center clinical trials are required to improve its indications in clinical treatment.

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Section: Discussionsupporting

confidence: 91%

Over-the-Scope Clip Applications as First-Line Therapy in the Treatment of Upper Non-variceal Gastrointestinal Bleeding, Perforations, and Fistulas

Qiu

Zhang

et al. 2022

Front. Med.

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“…This is consistent with a previous meta‐analysis comparing OTSC with CET that noted a lower 30‐day rebleeding rate in the OTSC group 14 . It may be explained by the reasons that OTSC achieves more effective hemostasis and efficient obliteration on arterial flow beneath the bleeding lesion because it can grasp a large amount of tissues, and that OTSC could stay in place for a long time due to its clamping force so that it may provide long‐lasting hemostatic efficacy 49 . However, it is currently not recommended as the first‐line therapy by the guidelines.…”

Section: Discussionsupporting

confidence: 91%

“…Abbreviations: CET, conventional endoscopic treatment; HP, hemostatic powder; OTSC, over-the-scope clip could stay in place for a long time due to its clamping force so that it may provide long-lasting hemostatic efficacy. 49 However, it is currently not recommended as the first-line therapy by the guidelines.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of new hemostatic techniques in nonvariceal gastrointestinal bleeding: A systematic review and network meta‐analysis

Gao

Bai

Wang

et al. 2023

J of Digest Diseases

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Objectives: Nonvariceal gastrointestinal bleeding (NVGIB) is a common medical condition with significant mortality and morbidity. Several types of hemostatic modalities are currently available in clinical setting. This systematic review and network meta-analysis aimed to assess the efficacy of these modalities in treating NVGIB.Methods: PubMed, EMBASE, and the Cochrane Library databases were searched for studies that compared the efficacy of different hemostatic techniques (over-thescope clip [OTSC], hemostatic powder [HP] and conventional endoscopic treatment [CET]) for NVGIB published up to June 2022. The 30-day rebleeding rate was regarded as the primary outcome. We performed pairwise and network metaanalyses for all treatments. The heterogeneity and transitivity were evaluated.Results: Twenty-two studies were included. Regarding the 30-day rebleeding rate, OTSC and HP plus CET showed superior efficacy in treating NVGIB compared with CET (OTSC vs CET: relative risk [RR] 0.42, 95% confidence interval [CI] 0.28-0.60; HP plus CET vs CET: RR 0.40, 95% CI 0.17-0.87), while OTSC and HP plus CET had comparable efficacy (RR 0.95, 95% CI 0.38-2.31). HP plus CET ranked the highest in the network ranking estimate. The sensitivity analysis showed that it was not robust that OTSC was superior to CET regarding the short-term rebleeding rate and the initial hemostasis rate. While all-cause mortality, bleeding-related mortality and necessity of surgical or angiographic salvage therapy showed no statistically significant difference.Conclusion: OTSC and HP plus CET significantly reduced 30-day rebleeding rate compared to CET and had comparable efficacy in the treatment of NVGIB.

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“…The use of the over-the-scope clip (Ovesco Endoscopy AG, Tübingen, Germany) is technically easy, time-saving, and reliable for mucosal closure. However, the persistent presence of the clip may interfere with endoscopic surveillance [28]. Other endoscopic suturing devices, e.g., the OverStitchTM suturing system (Apollo Endosurgery, Inc., Austin, TX, USA) and the ZEO suture M® (Zeon Medical Inc., Tokyo, Japan) [29], are also expected to close the post-ESD mucosal defects for the prevention of delayed bleeding and may provide similar chronological courses of sutured mucosa to those in EHS, although a technical difference in a suturing style (continuous suturing or nodule suturing) may affect the healing process of sutured sites.…”

Section: Discussionmentioning

confidence: 99%

Chronological Changes in Mucosal Deformity by Endoscopic Suturing after Gastric Endoscopic Submucosal Dissection: A Multicenter Retrospective Analysis

et al. 2022

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Introduction: Endoscopic suturing of a mucosal defect is expected to prevent postoperative bleeding after endoscopic submucosal dissection (ESD). Endoscopic suturing causes mucosal deformity, which may interfere with endoscopic surveillance thereafter. We retrospectively investigated long-term chronological changes in mucosal suturing by endoscopic suturing. Methods: Forty-three patients who underwent endoscopic hand suturing (EHS) after gastric ESD at three institutions were enrolled. First, our hypothesis that the suturing sites healed via inflammation, disappearance of mucosal inversion, and flattening was validated. Subsequently, the duration required to reach each healing step was evaluated. Results: A total of 137 follow-up endoscopies were assessed, in which all cases showed the hypothesized chronological course on the suturing sites. The 95th percentiles of the duration when showing the disappearance of the inflammatory change and the inverted change were 63 days and 15.5 months after the procedure, respectively. Discussion/Conclusion: The data show that the mucosal deformity induced by EHS disappeared within 16 months. Endoscopic suturing is thus considered to have a negligible effect on endoscopic surveillance following the procedure.

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Long-term outcomes of over-the-scope clip for refractory gastrointestinal diseases

Cited by 6 publications

References 25 publications

Over-the-Scope Clip Applications as First-Line Therapy in the Treatment of Upper Non-variceal Gastrointestinal Bleeding, Perforations, and Fistulas

Over-the-Scope Clip Applications as First-Line Therapy in the Treatment of Upper Non-variceal Gastrointestinal Bleeding, Perforations, and Fistulas

Efficacy of new hemostatic techniques in nonvariceal gastrointestinal bleeding: A systematic review and network meta‐analysis

Chronological Changes in Mucosal Deformity by Endoscopic Suturing after Gastric Endoscopic Submucosal Dissection: A Multicenter Retrospective Analysis

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