In 851 patients from 21 studies, definitive hemostasis was reached in 87.8 %, technical success in 97.8 %, and primary clinical success in 96.6 %.
V.T. Chandrasekar et al., Department of Gastroenterology and Hepatology, University of Kansas School of Medicine, Kansas City, Kansas, United States, conducted a comprehensive electronic database search for articles using OTSC for hemostasis aiming to determine technical and clinical success rates in achieving hemostasis as well as the rate of re-bleeding. All articles describing the use of OTSC for GI bleeding were reviewed. Case reports and smaller case series of fewer than five patients were excluded. The primary outcome was the rate of definitive hemostasis after primary technical and clinical success and without re-bleeding during follow-up.
A total of 21 studies comprising overall 851 patients met the inclusion criteria. 62.2 % of patients were males, median patient age was 69.7 years. 687 patients (80.7 %) were treated for upper GI bleeding and the remaining 164 patients (19.3 %) were treated for lower GI bleeding. OTSC was utilized as first-line treatment in 645 patients (75.8 %) and as second-line treatment in 206 patients (24.2 %). The definitive hemostasis rate was 87.8 % (95 % CI: 83.7 % – 92 %) during a median follow-up of 56 days. The rate of definitive hemostasis was 86.6 % (95 % CI: 81.9 % – 91.3 %) for upper GI bleeding and 89.5 % (95 % CI: 85.2 % – 93.8 %) for lower GI bleeding. The technical success rate was 97.8 % (95 % CI: 96.7 % – 98.9 %) and the primary clinical success rate was 96.6 % (95 % CI: 95.1 % – 98.2 %). Re-bleeding occurred in 10.3 % of patients (95 % CI: 6.5 % – 14.1 %). The failure rate of OTSC as first-line treatment was 9 % (95 % CI: 5.2 % – 12.8 %) and 26 % (95 % CI: 16.1 % – 36.0 %) when used as second line treatment. Only two adverse events requiring intervention were reported in 851 patients. In one patient with bleeding duodenal ulcer perforation occurred during OTSC placement which required surgery and another patient developed duodenal obstruction 1.8 months after OTSC placement; the obstruction could be resolved by three balloon dilations.
The authors concluded that this systematic review evaluating OTSC treatment of gastrointestinal bleeding showed high rates of definitive hemostasis, technical success, and primary clinical success, along with low re-bleeding rates. More randomized-controlled trials were desirable.
Efficacy and safety of Over-The-Scope-Clips for gastrointestinal bleeding: a systematic review and meta-analysis.
Chandrasekar VT, Desai M, Aziz M, Patel HK, Gorrepati VS, Jegadeesan R, Rai T, Sathyamurthy A, Murino A, Hassan C, Repici A, Sharma P..
Endoscopy 2019; 51: 941-949. https://doi.org/10.1055/a-0994-4361