Over-the-scope clip in peptic ulcer bleeding: clinical success in primary and secondary treatment and factors associated with treatment failure

Abstract

Background and study aims It is unclear if the clinical success rate of the over-the-scope-clip (OTSC) in peptic ulcer bleeding (PUB) is comparable when it is used in the first- or in the second-line of treatment. Patients and methods Data on endoscopic treatment (first- vs. second-line) in PUB with OTSC and clinical data were analyzed. The primary outcome was the clinical success of hemostasis, defined as the absence of recurrent bleeding or further intervention. Secondary outcomes were factors associated with OTSC failure. Results From April 2014 to March 2018, 100 patients (age 72 [20 – 98] y, female 36 %) with PUB in the stomach or the duodenum were treated endoscopically with the OTSC. The OTSC was used as a first-line procedure (primary-OTSC) in 66 pts. Successful hemostasis could be achieved in 90.9 %. After failure of an initial endoscopic treatment, 34 patients were treated with the OTSC (secondary-OTSC) and the treatment was successful in 94.1 %. Recurrent bleeding occurred in n = 10 for primary-OTSC (16.7 %) and in n = 7 pts in the secondary-OTSC (21.9 %) (P = 0.81). Clinical success in the primary-OTSC was 75.8 % and 73.5 % in the secondary-OTSC respectively. Conclusions The OTSC has a high rate of initial bleeding control in first- and second line treatment of PUB. OTSC failure occurs more often in the duodenum than in the stomach and results in longer intensive care unit stay, higher amount of transfusions, and a higher reimbursement per case.

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

“…Of these, 983 studies were excluded according to the predefined criteria and 49 studies were reviewed the full-text. Final literature search and selection according to the inclusion and exclusion criteria yielded 16 studies about OTSC system treatment for UNVGIB [11–13, 16–28]. Figure 1 showed the search and selection process.…”

“…Seven of 16 studies in our systematic review reported the reasons for OTSC treatment failure: 1) delayed closure of OTSC occurring in lesions with large caliber artery and those with deep fibrotic base; 2) shallow placement of OTSC resulting from inadequate suction or premature clip deployment; and 3) misplacement of OTSC because of poor visualization, difficult anatomy, and unstable endoscope position [11, 12, 18, 22, 23, 27, 28]. These failure causes of OTSC above may enlighten its further application in future.…”

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

“…Publication bias was assessed via visual inspection of the funnel plot and Egger's test, the P value of greater than 0.05 WAS CONSIDERED TO NO PUBLICATION BIAS [11]. [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]. 24.5%, P = 0.177).…”

“…Although this data was surprising, only 3.9% patient died related to OTSC system application failure and most of these patients died due to fatal comorbidity. Gölder S. et al deemed that in case of severe recurrent bleeding, the bleeding source could be controlled by endoscopic treatment, but the patient refused any further therapy and died, which was one of the reasons for the high mortality [27].…”

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

“…Of these, 983 studies were excluded according to the predefined criteria and 49 studies were reviewed the full-text. Final literature search and selection according to the inclusion and exclusion criteria yielded 16 studies about OTSC system treatment for UNVGIB [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]. Figure 1 showed the search and selection process.…”