OTSC reduces mortality compared to surgery in refractory ulcer bleeding

Multicentre comparative study of OTSC versus surgery shows comparable clinical success but lower complication rates and in-hospital mortality with OTSC for the treatment of refractory peptic ulcer bleeding (PUB)

Key findings

• OTSC showed comparable clinical success to surgery (74.2% in the OTSC group vs. 83.8% in the surgical group; p=0.329)
• OTSC treatment was associated with shorter ICU-stay (4.7 ± 6.6 days vs. 16.2 ± 18.0 days; p<0.001) and less severe adverse events (4.5% vs. 70.3%; p<0.001)
• In-hospital mortality was lower in the OTSC group compared to the surgery group (9.1% vs. 35.1%; p=0.003)

Study details

• Type / Period: Retrospective multicentre study of four German tertiary care centres / 2009 – 2019
• Population: 103 patients treated with OTSC (n=66; mean age 70.9 ± 13.4 years) or surgery (n=37; mean age 70.1 ± 11.3 years) for refractory PUB
• Aim: Comparison of outcomes (clinical success (defined as successful hemostasis and no rebleeding within seven days), adverse events, length of ICU-stay and in-hospital mortality) of OTSC treatment vs. surgery for refractory PUB
• Indications: Bleeding from gastroduodenal PUB and failure of at least one endoscopic treatment (persistent or recurrent bleeding)
• Age, comorbidities, anticoagulation therapy, number of pre-treatments, ulcer location, and Rockall-Score were similar in both groups
• Only difference was ulcer size, which was higher in surgical group (mean size 18.6 ± 7.4 mm vs. 23.0 ± 9.4 mm, p = 0.017))

Kuellmer A, Mangold T, Bettinger D, Schiemer M, Mueller J, Wannhoff A, Caca K, Wedi E, Kleemann T, Thimme R, Schmidt A. Reduced mortality for over-the-scope clips (OTSC) versus surgery for refractory peptic ulcer bleeding: a retrospective study. Surg Endosc. 2023;37(3):1854–62. doi:10.1007/s00464-022-09679-9.