Over-The-Scope Clip system as a first-line therapy for high-risk bleeding peptic ulcers: a retrospective study

Robles-Medranda, Carlos; Oleas, Roberto; Alcívar-Vásquez, Juan; Puga-Tejada, Miguel; Baquerizo-Burgos, Jorge; Pitanga-Lukashok, Hannah

doi:10.1007/s00464-020-07625-1

Cited by 12 publications

(15 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Furthermore, it is associated with high success rates for severe bleeding and was therefore suggested as primary therapy for high-risk patients. However, apart from one recent smaller RCT,17 data are mainly limited to retrospective studies with heterogeneous study populations and inconsistent definitions of high-risk lesions 16 18–21. We, therefore, aimed to investigate first-line OTSC treatment vs ST in patients with NVUGIB and high risk for rebleeding in a larger multicentre RCT.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Over-the-scope-clips versus standard treatment in high-risk patients with acute non-variceal upper gastrointestinal bleeding: a randomised controlled trial (STING-2)

Meier

Wannhoff

Denzer

et al. 2022

Gut

View full text Add to dashboard Cite

ObjectiveAcute non-variceal upper gastrointestinal bleeding (NVUGIB) is managed by standard endoscopic combination therapy, but a few cases remain difficult and carry a high risk of persistent or recurrent bleeding. The aim of our study was to compare first-line over-the-scope-clips (OTSC) therapy with standard endoscopic treatment in these selected patients.DesignWe conducted a prospective, randomised, controlled, multicentre study (NCT03331224). Patients with endoscopic evidence of acute NVUGIB and high risk of rebleeding (defined as complete Rockall Score ≥7) were included. Primary endpoint was clinical success defined as successful endoscopic haemostasis without evidence of recurrent bleeding.Results246 patients were screened and 100 patients were finally randomised (mean of 5 cases/centre and year; 70% male, 30% female, mean age 78 years; OTSC group n=48, standard group n=52). All but one case in the standard group were treated with conventional clips. Clinical success was 91.7% (n=44) in the OTSC group compared with 73.1% (n=38) in the ST group (p=0.019), with persistent bleeding occurring in 0 vs 6 in the OTSC versus standard group (p=0.027), all of the latter being successfully managed by rescue therapy with OTSC. Recurrent bleeding was observed in four patients (8.3%) in the OTSC group and in eight patients (15.4%) in the standard group (p=0.362).ConclusionOTSC therapy appears to be superior to standard treatment with clips when used by trained physicians for selected cases of primary therapy of NVUGIB with high risk of rebleeding. Further studies are necessary with regards to patient selection to identify subgroups benefiting most from OTSC haemostasis.Trial registration numberNCT03331224.

show abstract

Section: Discussionmentioning

confidence: 99%

“…These studies suggest that OTSC may also be effective as first-line therapy in high-risk patients. However, data on first-line OTSC treatment is scarce and the exact indications have not yet been defined 16–21…”

Section: Introductionmentioning

confidence: 99%

Over-the-scope-clips versus standard treatment in high-risk patients with acute non-variceal upper gastrointestinal bleeding: a randomised controlled trial (STING-2)

Meier

Wannhoff

Denzer

et al. 2022

Gut

View full text Add to dashboard Cite

show abstract

“…Fifty‐one potentially relevant articles were retrieved for further review, of which 29 were further excluded based on the publication type of case report (n = 1), data not extractable (n = 7), duplication (n = 19) and cost‐effectiveness analysis (n = 2) (Supplementary Table S2). Finally, 16 full‐text articles and 6 conference abstracts including a total of 2099 individuals 17,28–48 were enrolled for the systematic review and meta‐analysis. Among them, ten studies were RCTs, 28–37 two were prospective cohort studies, 38,39 and 10 were retrospective cohort studies 17,40–48 .…”

Section: Resultsmentioning

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

View full text Add to dashboard Cite

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.

show abstract

“…The OTSC is effective for closure of peptic ulcer perforation or fistula and as a first‐line treatment for severe peptic ulcer bleeding 4,5 …”

Section: Brief Explanationmentioning

confidence: 99%

“…1 The OTSC is effective for closure of peptic ulcer perforation or fistula and as a first-line treatment for severe peptic ulcer bleeding. 4,5 Here, we originally considered surgery because of the active bleeding, perforation, and shock. However, because of the high risk of complications due to severe obesity and the patient being on antithrombotic therapy, we selected OTSC, which allows simultaneous hemostasis and closure.…”

mentioning

confidence: 99%

Successful hemostasis and closure using an over‐the‐scope clip for perforated duodenal ulcer bleeding

Kubota

Wada

Tanabe

2022

Digestive Endoscopy

View full text Add to dashboard Cite

show abstract

Over-The-Scope Clip system as a first-line therapy for high-risk bleeding peptic ulcers: a retrospective study

Cited by 12 publications

References 17 publications

Over-the-scope-clips versus standard treatment in high-risk patients with acute non-variceal upper gastrointestinal bleeding: a randomised controlled trial (STING-2)

Over-the-scope-clips versus standard treatment in high-risk patients with acute non-variceal upper gastrointestinal bleeding: a randomised controlled trial (STING-2)

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

Successful hemostasis and closure using an over‐the‐scope clip for perforated duodenal ulcer bleeding

Contact Info

Product

Resources

About