OTSC®: Systematic meta-analysis with 914 patients shows superior clinical outcome in uppe…
Meta-analysis, comprising ten studies, showed that OTSC compared with standard therapy for severe NVUGIB, has a better clinical outcome, a significant reduction in the risk of 7-day and 30-day re-bleeding, and a shorter duration of treatment.
J. Bapaye et al., Rochester General Hospital, Rochester, New York, USA, performed a systematic review and meta-analysis of studies comparing the OTSC against standard therapy (STD) for high-risk non-variceal upper gastrointestinal bleeding (NVUGIB) as of April 2022. UGIB is still a common medical condition with significant mortality and morbidity.
The search for relevant studies was conducted on Medline, Embase, CENTRAL, Scopus, Web of Science, Ovid Medline, CINAHL, and Google Scholar including epub ahead of print, in-process & other non-indexed citations, without any time restriction up to April 2022. Studies without a control group, or in pediatric population, or studies where the OTSC was used to treat bleeds, which are not UGIB as well as non-English studies were excluded from this meta-analysis. Clinical success was defined as adequate intraprocedural hemostasis and prevention of rebleeding. In addition to clinical success rates and the pooled mean difference in procedure time, pooled rates and risk ratios for 7-day and 30-day rebleeding rates were calculated and compared.
A total of 10 studies, including 4 randomized control trials were pooled. The studies incorporate 914 patients of whom 431 were treated with an OTSC. The mean age range spanned from 55 to 79. The reported demographics in 9 studies accumulated to 211 females and 543 males. The pooled rebleeding rate at 7-days (reported in 6 studies) was 7.09 % (95 % CI 4.25-10.97 %) with OTSC and 18.77 % (95% CI 14.47-23.72%) with STD. The rate of 30-day rebleeding 9.51% (95% CI 6.91-12.68%) in the OTSC group and 21.95% (95% CI 18.33-25.91%) in the STD group. The clinical success (reported in 3 studies) rate was 87.29% (95% CI 81.28-93.30%) in the OTSC group and 63.93 % (95%CI 54.75-72.43%) in STD group. The OTSC group mean procedure time reported in 4 studies was shorter by 6.62 min (95% CI 2.58 min –10.67 min) compared to the STD therapy. Regarding the secondary outcomes mortality and length of hospitalization no statistically significant difference was found.
The authors therefore concluded that the OTSC System when used for high-risk NVUGIB’s significantly reduces rebleeding rates as compared to standard therapy, with higher clinical success rates and comparatively shorter procedure times.
A systematic review and meta-analysis of safety and efficacy of over the scope clips versus standard therapy for high-risk non-variceal upper gastrointestinal bleeding.
Bapaye J, Chandan S, Naing LY, Shehadah A, Deliwala S, Bhalla V, Chathuranga D, Okolo PI 3rd.
Gastrointest Endosc. 2022 Jul 5:S0016-5107(22)01806-5