OTSC Clips Ovesco Endoscopy

OTSC®| Multicenter RCT published in Gut – STING 2 trial

Multicenter RCT published in Gut – STING 2 trial on first line hemostasis shows superiority in non-variceal Upper GI bleeding

Multicenter randomized controlled trial including 100 patients with acute severe non-variceal upper gastrointestinal bleeding found a clinical success rate of 91.7 % with first line OTSC® therapy compared to a clinical success rate of 73.1 % with standard endoscopic management (p = 0.019). Persistent bleeding occurred in 0 patients in the OTSC group compared with 6 patients in the standard group (p = 0.027). Recurrent bleeding was observed in 4 patients (8.3 %) in the OTSC group and in 8 patients (15.4 %) in the standard therapy group (p= 0.362).

B. Meier et al., Gastroenterology, Klinikum Ludwigsburg, Ludwigsburg, Germany, conducted a multicenter randomized controlled trial aiming to compare first-line OTSC therapy with standard endoscopic treatment in patients with acute non-variceal upper gastrointestinal bleeding (NVUGIB) and high risk of rebleeding (defined as complete Rockall Score ≥7).

13 academic referral centers in Germany participated in the study. Endoscopic procedures were performed by 1-2 endoscopists per center, who all were highly experienced in management of GI bleeding and OTSC application (> 20 OTSC applications per year). The primary endpoint of clinical success was defined as successful endoscopic hemostasis without evidence of recurrent bleeding.
A total of 100 patients was included in the trial and randomised in two groups (OTSC group n=48, standard group n=52). 70% of patients were male, the mean age was 78 years. All but one case in the standard group were treated with conventional clips.
Clinical success was 91.7% (44/48) in the OTSC group versus 73.1 % (38/52) in the standard therapy group (p = 0.019). Persistent bleeding occurred in 0 patients in the OTSC group compared with 6 patients in the standard group (p = 0.027), all of the latter being successfully managed by immediate rescue therapy with OTSC. Recurrent bleeding was observed in 4 patients (8.3 %) in the OTSC group and in 8 patients (15.4 %) in the standard therapy group (p= 0.362).

The authors concluded that in experienced hands, primary OTSC therapy appears to be superior to standard treatment with conventional clips for selected cases of NVUGIB with high risk of rebleeding. The study also highlighted the efficacy of OTSC salvage therapy after unsuccessful initial hemostasis by standard endoscopic therapy. Further studies are necessary to identify subgroups benefiting most from OTSC hemostasis.

Over-the-scope-clips versus standard treatment in high-risk patients with acute non-variceal upper gastrointestinal bleeding: a randomised controlled trial (STING-2)
Meier B, Wannhoff A, Denzer U, Stathopoulos P, Schumacher B, Albers D, Hoffmeister A, Feisthammel J, Walter B, Meining A, Wedi E, Zachäus M, Pickartz T, Küllmer A, Schmidt A, Caca K
Gut Epub ahead of print 2022;0:1–8.
doi:10.1136/gutjnl-2021-325300

HAUT