J Brandler and colleagues, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA, performed a study on 67 patients with gastrointestinal bleeding from high-risk lesions who were treated with the OTSC System.
The definition of high-risk lesions was lesions situated in the area of a major artery and larger than 2 mm in diameter and /or a deep penetrating, excavated fibrotic ulcer with high-risk stigmata, in which perforation could not be ruled out or thermal therapy would cause perforation, or lesions that could not be treated by standard endoscopy (epinephrine injections, hemoclips, coagulation). Between 12/2011 and 02/2015, data from 67 patients with high risk non-variceal gastrointestinal bleeding, of which 49 received OTSCs as primary and 18 as rescue therapy, was prospectively collected and retrospectively analysed. Clinical severity was determined based on the Rockall score and a modified Blatchford score.
Out of 67 patients, 47 (70.1 %) remained free of re-bleeding at 30 days after OTSC placement. No difference was found in the proportion of patients with re-bleeding who received primary or rescue therapy (hazard ratio .639; 95%CI .084 – 4.860; P=.6653). Only 9 re-bleeding events were linked clearly to OTSCs and required intervention, indicating an OTSC success rate of 81.3%.
The authors concluded that OTSCs have a valuable role in managing and adverting high-risk radiologic or surgical interventions for non-variceal gastrointestinal bleeding, despite the presence of high risk of adverse outcome and severe prognostic scores.
Efficacy of Over-the-Scope Clips in Management of High-Risk Gastrointestinal Bleeding
Brandler J, Baruah A, Zeb M, Mehfooz A, Pophali P, Wong Kee Song L, AbuDayyeh B, Gostout C, Mara K, Dierkhising R, Buttar N (2017)
Clin Gastroenterol Hepatol. 2017 Jul 26. pii: S1542-3565(17)30857-1. doi: 10.1016/j.cgh.2017.07.020.