Efficacy and safety of over-the-scope clips for gastrointestinal bleeding: a systematic review and meta-analysis

Abstract

Background The over-the-scope clip (OTSC) has been increasingly utilized for the management of gastrointestinal (GI) bleeding. Limited efficacy data are currently available from large-scale studies. Methods An electronic database search was conducted for eligible articles using OTSCs for hemostasis in GI bleeding. The primary outcome was the rate of definitive hemostasis after primary hemostasis and without rebleeding at follow-up. Secondary outcomes were: primary technical success, primary clinical success, rebleeding, and failure rates. Pooled rates were expressed as proportions of patients with events over total patients, 95 % confidence limits (CI) with heterogeneity, and P values of < 0.05 for significance. Results A total of 21 studies (n = 851) were analyzed (62.2 % males), with a median patient age of 69.7 years. The definitive hemostasis rate was 87.8 % (95 %CI 83.7 % – 92 %) after a median follow-up of 56 days. The OTSC was successfully deployed in 97.8 % of patients (95 %CI 96.7 % – 98.9 %) and the primary clinical success rate was 96.6 % (95 %CI 95.1 % – 98.2 %). Rebleeding was seen in 10.3 % of patients (95 %CI 6.5 % – 14.1 %). The failure rate of OTSCs was 9 % (95 %CI 5.2 % – 12.8 %) when used as first-line treatment and 26 % (95 %CI 16.1 % – 36.0 %) when used as second-line treatment. Conclusion This systematic review showed high rates of definitive hemostasis, technical success, and clinical success, along with low rebleeding rates when OTSCs were used for the treatment of GI bleeding. The lack of randomized controlled trials of OTSC vs. other therapies makes comparison with conventional treatment difficult.

Endoscopic diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH): European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2021

“…In a systematic review and meta-analysis, Chandrasekar et al examined the effectiveness of cap-mounted clip technology in achieving "definitive hemostasis" in GI bleeding, defined as successful primary hemostasis without rebleeding during the follow-up period (median 56 days) [138]. This meta-analysis included 21 studies (1 RCT, 20 observational) with 851 patients (687 with UGIH).…”

Endoloop rescue therapy for a duodenal ulcer that re-bled under the clip base after application of an 11/3 traumatic over-the-scope clip

“…In conclusion, it has been shown that the OTSC is a safe hemostatic tool [1,2]; however, our case shows that precise E-Videos Video 1 Duodenal ulcer that was re-bleeding from under the clip base after application of a 11/3 traumatic over-the-scope clip (OTSC). An endoloop was applied as endoscopic rescue therapy when the OTSC failed to control bleeding.…”

Outcomes of over-the-scope clip application in various gastrointestinal indications: experience from a tertiary care in India

“…Rebleeding was seen in 10.3% of patients. The failure rate of OTSCs was 9% when used as primary therapy and 26% when used as rescue/salvage therapy [ 17 ]. The data are limited regarding the use of OTSC as a primary therapy [ 4 ].…”