Over-the-scope-clips may be more effective than standard treatment for some patients with nonvariceal upper gastrointestinal bleeding

Abstract: https://www.acpjournals.org/doi/10.7326/M22-1783

Editorial: https://www.acpjournals.org/doi/10.7326/M23-0449

URL goes live when the embargo lifts

A randomized controlled trial of adults with active bleeding or a nonbleeding visible vessel from a nonvariceal cause on upper gastrointestinal endoscopy found that over-the-scope-clips (OTSCs) as an initial treatment may be better than standard treatment in reducing the risk for further bleeding from some nonvariceal upper gastrointestinal causes. The findings are published in Annals of Internal Medicine.

The current standard in endoscopic hemostasis includes the use of hemo-clips or contact thermal devices, but the failure rate with these methods may be up to 10 percent and further bleeding after endoscopic hemostasis increases mortality risk. OTSCs, which memory-shaped nitinol clips that are cap mounted onto the end of an endoscope, can be used in hemostasis. Currently, OTSCs are primarily used in severe or refractory bleeding from nonvariceal causes.

Researchers from several university hospitals in Hong Kong, China and Australia conducted a randomized controlled trial of 190 adult patients with active bleeding or a nonbleeding visible vessel from a nonvariceal cause on upper gastrointestinal endoscopy. Ninety-seven participants were assigned to receive standard treatment, and 93 received treatment using OTSCs. The authors found that the 30-day probability for bleeding in the standard treatment group was 14.6 percent and 3.2 percent for the OTSC group. However, while the findings suggest the use of OTSCs may be better than standard treatment in preventing further bleeding, the authors are not advocating routine primary use of OTSCs. Instead, they suggest that primary use of OTSCs may find a role in the treatment of ulcers predicted to fail standard endoscopic treatment.

An accompanying editorial from McGill University Health Centre supports the authors’ conclusion that their findings do not suggest that OTSCs should be used as an initial treatment for nonvariceal upper gastrointestinal bleeding. They say that while endoscopists should be trained in their use, OTSCs are also expensive compared to other therapies.  The editorialists say that OTSCs should be reserved for patients lesions at high risk for failure with standard treatments, such as those bleeding from ulcers exceeding 2 cm or located high in the gastric lesser curvature or posterior duodenal bulb.

 

Media contacts: For an embargoed PDF, please contact Angela Collom at [email protected]. To speak with the corresponding author, James Y.W. Lau, MD, please email   [email protected].