Clinical outcomes of over-the-scope-clip system for the treatment of acute upper non-variceal gastrointestinal bleeding: a systematic review and meta-analysis

Abstract

Background: Conventional endoscopic treatments can’t control bleeding in as many as 20% of patients with non-variceal gastrointestinal (GI) bleeding. Recent studies have shown that over-the-scope-clip (OTSC) system allowed for effective hemostasis for refractory GI bleeding lesions. So we aimed to conduct a systematic review to evaluate the effectiveness and safety of the OTSC system for management of acute non-variceal upper GI bleeding. Method: A comprehensive literature search was conducted on PubMed, EMBASE, and Cochrane Library covering the period from January 2007 to May 2019. The literature was selected independently by two reviewers according to the inclusion and exclusion criteria. The statistical analysis was carried out using Comprehensive Meta-Analysis software version 3.0. Results: A total of 16 studies including 769 patients with 778 GI bleeding lesions were identified. Pooled technical success was achieved in 761 lesions [95.7%; 95% confidence interval (CI), 93.5%-97.2%], and the pooled clinical success was achieved in 666 lesions (84.2%; 95% CI, 77.4%-89.2%). The incidence of re-bleeding was reported in 81 patients and the post-procedure mortality was 10.9% (n = 84). Only 2 (0.3%) patients occurred complications after OTSC system procedure. Conclusions: Our study demonstrated that the OTSC system was a technically feasible modality and highly efficacious in achieving hemostasis in acute non-variceal upper gastrointestinal bleeding.

Over-the-Scope Clip-Associated Endoscopic Muscular Dissection for Seven Cases of Small Gastric Submucosal Tumor: A Video-Based Case Series

“…ESD is used for treating early carcinoma of digestive tract at first, along with the expansion of indications; now it is becoming the most common therapeutic method for GSMT 5 Gastroenterology Research and Practice [7]. OTSC is usually used for gastrointestinal bleeding, fistula, and endoscopic iatrogenic perforation [8][9][10][11][12][13][14] and also used for closing anastomotic leakage after colorectal cancer surgery [15] and entry site closure in POEM and G-POEM [16]. Recently, OTSC is reported using for prophylactic closure in ESD or EFTR in order to make the procedure safer and more effective [5,6], as well as endoscopic suture [17].…”

Endoscopic band ligation and over-the-scope clip placement for refractory bleeding of Dieulafoy ulcer in the jejunum

“…Clipping using an OTSC is effective as first-line and second-line treatment for peptic ulcers [1,2]. The hemostasis rate with OTSC is reported to be 64.7 % -100 % [3]. In some cases, EBL will incorporate even the muscularis propria and serosa of a lesion, with a high risk of perforation reported for lesions in the small intestine [4,5].…”