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Abstract
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.
Methods
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.
Results
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).
Conclusions
OTSC-a should be the preferred option for duodenal ulcer bleeding if the endoscopist
aims for an over-the-scope-clip.
Graphical abstract
Graphical Abstract
Keywords
Abbreviations:
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
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Article info
Publication history
Accepted:
January 28,
2023
Received in revised form:
January 27,
2023
Received:
August 13,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 by the American Society for Gastrointestinal Endoscopy
