Use of over-the-scope clips (OTSC) for hemostasis in gastrointestinal bleeding in patients under antithrombotic therapy

Abstract

Background and study aims In patients taking different regimens of antithrombotic and/or anticoagulant therapy, endoscopic management of gastrointestinal bleeding represents a major challenge due to failing endogenous hemostasis. In this retrospective study we report on success rates with the over-the-scope clip (OTSC) system in upper and lower gastrointestinal bleeding in this high-risk patient population. Patients and methods Between February 2011 and June 2014, 75 patients were treated with an OTSC for active gastrointestinal bleeding. Success rates with the first endoscopic therapy, rebleeding episodes, their management and the influence of antithrombotic or anticoagulant therapy were analyzed retrospectively. Results Application of the OTSC resulted in immediate hemostasis (primary success rate) in all 75 patients. However, in 34.7 % a rebleeding episode was noted that could be treated by further endoscopic interventions. Only 3 patients had to be sent to the operating room because of failure of endoscopic therapy. In the rebleeding group the use of antiplatelet therapies was higher (73.1 % vs. 48.9 %). Conclusions Application of the OTSC in GI bleeding results in a high rate of primary hemostasis. Rebleeding occurs in up to 35 % of patients receiving antithrombotic/anticoagulant therapy but can be managed successfully with further endoscopic treatments. Patients in the rebleeding group were more frequently treated with antiplatelet agents. Radiological or surgical therapy was reserved for a small subgroup not successfully managed by repeated endoscopic therapies. OTSC application is the treatment of choice in high-risk patients when conventional clips used as first-line treatment fail.

Endoscopic Management of Post-Polypectomy Bleeding

“…The over-the-scope clip (OTSC; Ovesco Endoscopy, Tubingen, Germany) has been more extensively studied in the treatment of upper gastrointestinal bleeding but has also been demonstrated to be an effective salvage therapy option in patients with PPB. [70][71][72][73] Moreover, contact hemostasis powder spray (Hemospray; Cook Medical, Bloomington, IN, USA) has been used to successfully treat PPB. [74][75][76][77] Given that hemostasis powder will slough off some interval after treatment, studies 76,77 have shown higher rates of re-bleeding within the first 72 h and that re-bleeding is more likely to occur with an actively spurting bleed and with a background of hemodynamic instability.…”

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

“…Conversely, some authors concluded that OTSC system might be considered as a secondary option for high-risk patients after conventional endoscopic hemostasis failed [17][18][21][22]. Therefore, OTSC may be considered as first-line treatment for UNVGIB in high risk patients and rescue treatment for initial failed hemostasis with conventional endoscopic methods.…”

“…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.…”

The causes of upper gastrointestinal bleeding and urgent gastroscopy at the Center for Emergency Medicine of the Clinical Center Kragujevac

“…Duodenal ulcers are definitely the leading cause of bleeding from the upper parts of the digestive tract [16]. Two traditional types of endoscopic therapy are the adrenaline therapy and the clip-based therapy [17,18]. Esophagogastroduodenoscopy is an efficient method for the diagnosis and treatment of the patients with bleeding from the upper parts of digestive tract [19].…”