Research Article|Articles in Press

A Comparison between Traumatic and Atraumatic Over-The-Scope-Clips in patients with Duodenal Ulcer Bleeding: a Retrospective Analysis with Propensity-Score-based Matching

Published:February 02, 2023DOI:
      This paper is only available as a PDF. To read, Please Download here.


      Background and aims

      The over-the-scope-clip (OTSC) substantially improved the endoscopic armamentarium for the treatment of severe gastrointestinal bleeding and can potentially overcome limitations of standard clips. Recent data indicated a superiority of OTSC in hemostasis as first and second line therapy. However, the impact of the OTSC design (traumatic (-t) or atraumatic (-a) type) in particular in duodenal ulcer bleeding has not been analyzed so far.


      Retrospective analysis of a prospective collected database from 2009 until 2020 of six German endoscopic centers. All patients who underwent emergency endoscopy and were treated by an OTSC for duodenal ulcer bleeding were included. OTSC-t and OTSC-a patients were compared by Fisher’s exact test, chi-square- or Mann-Whitney U-test as appropriate. A propensity-score based 1:1 matching was performed to obtain equal distribution of baseline characteristics in both groups.


      The entire cohort comprised 173 patients (93 OTSC-a, 80 OTSC-t). Age, gender, anticoagulant therapy, Rockall-Score and treatment regimen had similar distributions in the two groups. However, OTSC-t group showed significantly more active bleeding ulcers (Forrest Ia/b). Matching identified 132 patients (66 in both groups) with comparable baseline characteristics. Initial bleeding hemostasis (OTSC-a: 90.9%, OTSC-t: 87.9%, p=0.82) or 72h-mortality (OTSC-a: 4.5%, OTSC-t: 6.0%, p>0.99) were not significantly different but the OTSC-t group revealed a clearly higher rate of rebleeding (34.9% vs. 7.6%, p<0.001) and necessity of red blood cell transfusions (5.1±3.4 vs. 2.5±2.4 concentrates, p<0.001).


      OTSC-a should be the preferred option for duodenal ulcer bleeding if the endoscopist aims for an over-the-scope-clip.

      Graphical abstract



      95%CI (95% confidence interval), AEs (adverse events), DOAC (direct oral anticoagulant), INR (International Normalized Ratio), NVUGIH (non-variceal upper gastrointestinal hemorrhage), OTSC (over-the-scope-clip), OTSC-a (atraumatic over-the-scope-clip), OTSC-t (traumatic over-the-scope-clip), RBC (red blood cell), RCT (randomized controlled trial), SD (standard deviation), SMD (standardized mean difference), TTS (through-the-scope)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Gastrointestinal Endoscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect