OTSC® first-line hemostasis: a comparison to standard therapy

A comparison study on OTSC® vs standard endoscopic therapy as first-line treatment in ulcers with high-risk re-bleeding stigmata showed higher intra-procedural hemostasis rates (95.2 % vs 83.0 %, p = 0.256) lower re-bleeding rates (9.5 % vs. 21.3 % p = 0.317), and shorter procedure duration (16 vs. 23 minutes, p = 0.002) with OTSC®, while costs of intervention were comparable ($ 438 in the OTSC® vs. $ 398 in the standard therapy group, p = 0.203).

Buddam A et al., Creighton University School of Medicine, Omaha, NE, USA performed a comparison study on OTSC® as first-line therapy in ulcers with high-risk stigmata versus standard endoscopic therapy. Consecutive patients who underwent endoscopic therapy between 07/2019 and 09/2020 for upper gastrointestinal bleeding (UGIB) from non-malignant ulcer with high-risk stigmata were included. Selection of first-line therapeutic strategy (either OTSC® or standard therapy) was based on endoscopist preference. Subsequent endoscopies for recurrent bleeding were not included in the analysis. Primary outcomes measured were: intra-procedural hemostasis, 7-day re-bleeding rate, procedure duration, and cost of endoscopic interventions.

A total of 68 patients were included, 21 with OTSC® treatment and 47 with standard therapy. The two groups were similar in age, sex, anticoagulant or antiplatelet agent use, admission Glasgow-Blatchford bleeding score, etiology of ulcer, location of ulcer, and type of high-risk stigmata. Hemostasis was achieved in 95.2 % in the OTSC® group versus 83.0 % in the standard therapy group (p = 0.256, number needed to treat: 9). 5 patients in the standard therapy group needed OTSC® as rescue therapy to achieve hemostasis during the index endoscopy. Procedure time was shorter in the OTSC® group (16 vs. 23 minutes, p = 0.002). Early re-bleeding occurred in 2 patients (9.5 %) in the OTSC® group compared to 10 patients (21.3 %) in the standard therapy group, (NNT 9). Cost of endoscopic interventions were comparable ($ 438 in the OTSC® vs. $ 398 in the standard therapy group, p = 0.203). None of the patients from the OTSC® group had 30 day re-bleeding or related readmission whereas 2 patients (4.4 %) in the standard group had readmissions from re-bleeding.

The authors concluded that the use of OTSC® as first-line therapy for ulcers with high-risk stigmata improves hemostasis and decreases early re-bleeding when compared to standard endoscopic treatment. Besides, it shortens procedure duration without increasing the cost of endoscopic interventions.

Over-the-scope clip as first-line therapy for ulcers with high-risk bleeding stigmata is efficient compared to standard endoscopy therapy
Buddam A, Rao S, Koppala J, Rangray R, Abdussalam A, Mukherjee S, Chandra S.
Endosc Int Open 2021; 09: E1530–E1535.
DOI: 10.1055/a-1526-0754