OTSC®: 100 % clinical success rate without any complications in patients with perforated peptic ulcer

106 patients with perforated peptic ulcer were treated with OTSC (n = 26) or conservative therapy (n = 80). In the OTSC group, technical and clinical success was achieved in 100 % of patients without any complications, the median operation time was 10 min. In the control group, the clinical success rate was 57.5 %, the mortality rate was 13.8 % and subsequent surgeries were required in 30 % of patients.

J. Wei et al., Endoscopic Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China, conducted a retrospective study on 106 patients with perforated peptic ulcer.

26 of those patients were treated with OTSC and 80 were treated with pharmacotherapies as the initial choice. No significant differences in age (p = 0.073), gender composition (p = 0.182), Boey score (p = 0.847) or MPI (Mannheim Peritonitis Index) score (p = 0.113) were noted between the two treatment groups. The mean lesion size of perforation was 5.0 ± 1.0 mm in the OTSC group and lesions were located to duodenal (n = 18), gastric (n = 7), and anastomotic (n = 1) regions. In the control group, the sites of perforation were not specified in up to 70 % of patients who were examined radiologically. The sites of perforation were located in the duodenal bulb (n = 17) and stomach (n = 7) in the patients who underwent laparotomy. The technical success rate in the OTSC group was 100 %. None of the patients experienced any complications associated with OTSC placement. The mean procedure time was 10.0 ± 2.5 min. The clinical success rate was 100 % (26 / 26) in the OTSC group and 57.5 % (46 / 80) in the control group. Subsequent surgery for diagnosis and/or treatment of recurrent ulcer after discharge from hospital including abdominal laparotomy and peritoneal lavage were not required for any of the patients in the OTSC group but were required for 30.0 % (24 / 80) of patients in the control group (p < 0.001). All patients in the OTSC group were discharged from the hospital. However, the mortality rate was 13.8 % (11 / 80) in the control group. The causes of death were uncontrolled sepsis followed by advanced multiple organ failure (8 / 11), heart failure (2 / 11), and gastrointestinal bleeding (1 / 11). The time to oral feeding was significantly shorter in the OTSC group (3.5 days, IQR 2.0 – 5.25) compared with the control group (7.0 days, IQR 5.0 – 9.0; p < 0.001). However, no significant difference was noted in the length of hospital stay (p = 0.439) or antibiotic use (p = 0.237).

The authors discussed that the advantage of OTSC therapy for perforated peptic ulcer therapy is that the procedure enables clear location of the perforation, accurate evaluation of lesion sizes, and reliable assessment of the patients’ response to therapy.

The authors concluded that the OTSC-based endoscopic treatment of perforated peptic ulcers is associated with a very high clinical success rate and low complication rate.

Over-the-scope-clip applications for perforated peptic ulcer
Wei J, Xie XP, Lian TT, Yang ZY, Pan YF, Lin ZL, Zheng GW, Zhuang Z.
Surgical Endoscopy 2019; 33:4122-4127. https://doi.org/10.1007/s00464-019-06717-x