Safety and efficacy of over-the-scope clips versus standard therapy for high-risk nonvariceal upper GI bleeding: systematic review and meta-analysis

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

“…We found that OTSC and HP + CET significantly reduced 30‐day rebleeding rates compared to CET with comparable efficacy. Moreover, it was not robust on the superiority of OTSC to CET regarding the short‐term rebleeding rate, which is inconsistent with the previous meta‐analysis 14 . Further head‐to‐head trials on OTSC, CET, and HP are necessary to further confirm our results.…”

“…We found that OTSC and HP + CET were superior to CET regarding the 30‐day rebleeding rate for NVGIB. This is consistent with a previous meta‐analysis comparing OTSC with CET that noted a lower 30‐day rebleeding rate in the OTSC group 14 . It may be explained by the reasons that OTSC achieves more effective hemostasis and efficient obliteration on arterial flow beneath the bleeding lesion because it can grasp a large amount of tissues, and that OTSC could stay in place for a long time due to its clamping force so that it may provide long‐lasting hemostatic efficacy 49 .…”

“…Moreover, our sensitivity analysis pointed out that the results comparing OTSC and CET were not robust regarding the short‐term rebleeding rate and the initial hemostasis rate. A previous meta‐analysis including six studies reported the a pooled RR of rebleeding at 7 days with OTSC compared with CET of 0.41 (95% CI 0.24–0.68, I 2 = 0%) 14 . However, we could not draw a solid conclusion based on the efficacy of OTSC and CET for the short‐term rebleeding rate and the initial hemostasis rate, and large‐scale randomized controlled trials are needed.…”

“…OTSC has been used for the treatment of nonvariceal upper gastrointestinal bleeding (NVUGIB), especially as a salvage therapy when conventional hemostatic techniques fail, showing a favorable outcome 13 . A meta‐analysis evaluating the efficacy of OTSC in NVUGIB reported that OTSC showed lower 7‐day and 30‐day rebleeding rates than CET 14 . However, OTSC is not widely applied in clinical practice due to its high cost and the requirement of additional endoscopic skills 15,16 .…”

An update on the management of non-variceal upper gastrointestinal bleeding

“…It has been shown to be efficacious as rescue compared to standard therapy (TTS clips, principally) in decreasing persistent bleeding amongst patients presenting with high-risk endoscopic bleeding ulcer lesions who have experienced recurrent bleeding [ 95 ]. Since that time, additional RCTs assessing its role as primary therapy in NVUGIB have suggested its efficacy in decreasing rebleeding at 7 and 30 days, as has a recent meta-analysis that regrouped both observational studies and RCTs [ 96 ]. However, a number of methodological limitations leading to lower certainty of evidence have been raised that have questioned adopting this technology as primary therapy in NVUGIB, let alone peptic ulcer bleeding [ 97 ].…”