Large multicenter study with 286 patients confirms safety and efficacy of the OTSC® for hemostasis of high-risk lesions

96.4 % hemostasis rate is reported from 286 emergency endoscopies for either upper or lower gastrointestinal bleeding in whom the OTSC was used as first-line therapy.

Manta R et al., Digestive Endoscopy Unit, S.Agostino-Estense Hospital, Modena, Italy, published a study comprising data from all patients with upper or lower gastrointestinal bleeding from eleven Italian tertiary endoscopic referral centers who underwent OTSC placement as first-line treatment between 2014 and 07/2017. The decision to use an OTSC as first-line endoscopic treatment depended on the endoscopist’s evaluation. Briefly, all high-risk patients and/or those with high-risk bleeding lesions were considered for the OTSC approach. Patients on antithrombotic therapy and those with relevant comorbidities (heart, kidney, and hepatic impairment) were considered as high-risk. Bleeding lesions were classified as high-risk when at least one of the following conditions was present: lesion with bleeding artery or vessel larger than 2 mm in diameter visible, lesion deeply penetrating, excavated or fibrotic in which the presence of a microperforation could not completely be ruled out or thermal therapy could increase risk of perforation, and lesion not suitable for safe treatment by other endoscopic devices.

Overall 286 patients with either UGIB (n=214) or LGIB (n=72) were included. 112 patients (39.2 %) were receiving antithrombotic therapy at the time of the intervention. Technical success and primary hemostasis rates were 97.9 % and 96.4 %, respectively. Early re-bleeding occurred in 4.4 %, more frequently in those with antithrombotic therapy, and no late re-bleeding was observed. Following a successful primary hemostasis, only 5.2 % of patients needed blood transfusions, the median hospital stay was 4 days (range 3 -11). 18 patients with either technical failure (n=6) or re-bleeding (n=12) underwent radiological or surgical approaches. Overall, bleeding–related deaths occurred in 5 patients (1.7 %), including 3 patients with technical procedural failure and 2 in the re-bleeding group.

The authors conclude that the data from this large multicenter study show that OTSC placement is an effective first-line treatment for hemostasis in high-risk patients with lesions in the upper or lower gastrointestinal tract.

First-line endoscopic treatment with over-the-scope clips in patients with either upper or lower gastrointestinal bleeding: a multicenter study.
Manta R, Mangiafico S, Zullo A, Bertani H, Caruso A, Grande G, Zito FP, Magniavillano B, Pasquale L, Parodi A, Germana B, Bassotti G, Monica F, Zilli M, Pisani A, Mutignani M, Conigliaro R, Galloro G.
Endoscopy International Open 2018;06:E1317-E1321.