In a multicentric cohort of 100 consecutive patients with mean age 72 y, 51 % severe cardiovascular comorbidity, and 73 % on antiplatelet or/and anticoagulation therapy presenting with non-variceal upper GI bleeding from ulcers with median size of 3 cm, OTSC therapy led to 94 % primary hemostasis and 86 % long-term clinical success.
Non-variceal upper gastrointestinal bleeding (NVUGIB) is a common clinical problem with high rates of morbidity and a mortality rate between 5-10 %. An aging patient population with a high prevalence of cardiovascular comorbidity has led to increase in the incidence of NVUGIB in patients older than age 70 years. A high comorbidity rate has also been identified as an independent risk factor for complications and mortality after NVUGIB.
Wedi E et al., Department of Gastroenterology und GI Oncology, University Medical Centre Goettingen, Germany presented prospectively collected multicentric data from 02/2009 to 09/2015 from all patients who underwent emergency endoscopy for high-risk NVUGIB in two academic centers and were treated with OTSC as first-line (n=81) or second-line therapy (n=19). 100 consecutive patients (mean age 72 years, range 27-97) were included in the study. 51 % had severe cardiovascular comorbidity (ischemic heart disease, congestive heart failure, hypertension, valvular heart disease, peripheral arterial occlusive disease and atrial fibrillation) and 73 % were on antiplatelet or/and anticoagulation therapy, other comorbidities in the patient cohort included kidney disease (n=20), former or recent malignancy (n=23), respiratory disease (n=16), liver disease (n=6) and diabetes mellitus (n=26). The median size of the treated ulcers was 3 cm (range 1-5 cm), the patients in 85 % of cases were classified as ASA 3 to 5 (ASA 3: 40 %, ASA 4: 40 %, and ASA 5: 5 %). In 94 % of patients (n=94) primary hemostasis with OTSC was achieved. The primary endpoint with successful initial hemostasis and no early (≤ 24 h) or delayed (≤ 30 days) re-bleeding was achieved in 86 % of patients. Mean number of OTSCs placed on the initial endoscopic exam was 1 (range 1-3). Long-term hemostasis (6 months) was achieved in 86 %.
The authors concluded that in this cohort the OTSC System was demonstrated to be a safe and effective first-and second-line treatment for NVUGIB in high-risk patients with cardiovascular disease and complex, large ulcers.
Use of the over-the-scope-clip (OTSC) in non-variceal upper gastrointestinal bleeding in patients with severe cardiovascular comorbidities: a retrospective study
Wedi E, von Renteln D, Gonzalez S, Tkachenko O, Jung C, Orkut S, Roth V, Tumay S, Hochberger J
Endoscopy International Open 2017; 05: E875–E882 | http://dx.doi.org/10.1055/s-0043-105496