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Successful application of OTSC in GI bleeding under antithrombotic/anticoagulant therapy

100 % primary hemostasis rate and improved management of rebleeding with OTSC® used as first line therapy

Lamberts R and colleagues, HELIOS Park-Hospital, Department II for Internal Medicine, Leipzig, Germany, conducted a retrospective study examining success rates in hemostasis of acute upper and lower gastrointestinal bleeding with the OTSC System as first or second line therapy in patients taking different regimens of antithrombotic and/or anticoagulant therapy.

Overall 75 consecutive patients (mean age 71.7, 55 men, 20 women) with active gastrointestinal bleeding were analysed. 34 patients (45.3 %) were under antiplatelet monotherapy, 10 patients (13.3 %) under dual antiplatelet therapy, 13 patients (17.3 %) under inhibitors of plasmatic coagulation, and 18 patients (24.0 %) no antithrombotic/anticoagulant therapy. OTSC was the first-line treatment in 45 (60 %) patients, in 30 patients (40 %) it was used in second line after preceding hemostasis attempts with conventional clips, adrenalin injection, fibrin glue and/or APC therapy. Key outcomes measured were: success rate with the OTSC therapy, rebleeding episodes, their management and the influence of antithrombotic or anticoagulant therapy.

Application of the OTSC resulted in immediate hemostasis in all 75 patients (100 % primary success rate). In 26 patients (34.7 %) a rebleeding episode was noted. In the group of first-line OTSC treatment the rebleeding rate was 28.9 % (13/45) compared to 43.3 % (13/30) in the group of second line OTSC treatment. In 23 patients rebleeding could be treated by further endoscopic interventions. Only 3 patients had to undergo radiological or surgical treatment because of final failure of endoscopic therapy attempts. In the rebleeding group the use of antiplatelet therapies was higher (73.1 % vs 48.9 %).

The authors concluded that primary OTSC application should be the treatment of choice in this high-risk patient population. Repeated endoscopic treatments to achieve definitive hemostasis may be justified and show promising results.

Use of over-the-scope clips (OTSC) for hemostasis in gastro-intestinal bleeding in patients under antithrombotic therapy
Lamberts R, Koch A, Binner C, Zachaeus M, Knigge I, Bernhardt M, Halm U (2017)
Endoscopy International Open 2017; 05: E324-E330