Over-the-scope clip placement is effective rescue therapy for severe acute upper gastrointestinal bleeding

Abstract

Background and study aim: The novel over-the-scope clip (OTSC) allows for excellent apposition of tissue, potentially permitting hemostasis to be achieved in various types of gastrointestinal lesions. This study aimed to evaluate the usefulness and safety of OTSCs for endoscopic hemostasis in patients with upper gastrointestinal bleeding in whom traditional endoscopic methods had failed. Patients and methods: A retrospective case series of all patients who underwent placement of an OTSC for severe recurrent upper gastrointestinal bleeding over a 14-month period was studied. Outcome data for the procedure included achievement of primary hemostasis, episodes of recurrent bleeding, and complications. Results: Twelve consecutive patients (67 % men; mean age 59, range 29 – 86) with ongoing upper gastrointestinal bleeding despite previous endoscopic management were included. They had a mean ASA score of 3 (range 2 – 4), a mean hemoglobin of 7.2 g/dL (range 5.2 – 9.1), and shock was present in 75 % of patients. They had all received packed red blood cells (mean 5.1 units, range 2 – 12). The etiology of bleeding was: duodenal ulcer (n = 6), gastric ulcer (n = 2) Dieulafoy lesion (n = 2), anastomotic ulceration (n = 1), Mallory – Weiss tear (n = 1). Hemostasis was achieved in all patients. Rebleeding occurred in two patients 1 day and 7 days after OTSC placement. There were no complications associated with OTSC application. Conclusions: OTSC use represents an effective, easily performed, and safe endoscopic therapy for various causes of severe acute gastrointestinal bleeding when conventional endoscopic techniques have failed. This therapy should be added to the armamentarium of therapeutic endoscopists.

Endoscopic closure devices: A review of technique and application for hemostasis

“…28 Similarly, a study of 12 patients with upper GI bleeding (i.e., duodenal ulcers, gastric ulcers, Dieulafoy lesion, anastomotic ulceration, and Mallory-Weiss tear), whom failed traditional endoscopic methods, showed similar results with hemostasis achieved in all subjects. 29 Another case series also reported a technical success rate of 100% in 10 refractory cases with a median size ulcer of 2.5 cm. 30 A prospective study of 40 consecutive patients also achieved technical success and primary hemostasis in 100% of patients using OTSC as first line therapy, with no complications or rebleeding during the 30-day follow up period.…”

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

“…Primary failure defined as continuous bleeding after OTSC placement. Re-bleeding was defined as development of fresh hematemesis, melena, hematochezia, shock, or a drop in hemoglobin of more than 2 g/dL within 24 hours, with need for repeat treatment [17][18]27]. Technical success defined as successful placement of the OTSC on the target lesion.…”

Guidelines for the diagnosis and treatment of acute non‐variceal upper gastrointestinal bleeding (2015, Nanchang, China)

“…For patients whose bleeding cannot be controlled using conventional hemostatic methods, recent clinical reports have evaluated the use of Hemospray or the Over‐The‐Scope‐Clip (OTSC) system for hemostasis. Preliminary studies have shown that these modalities exhibit a higher hemostatic rate and lower rebleeding rate; however, there is still a lack of high‐quality controlled studies comparing Hemospray or OTSC with traditional methods.…”