High-risk GI bleeding: primary hemostasis in first-line OTSC treatment in 95%

HJ Richter-Schrag and colleagues, Center of Interdisciplinary Gastrointestinal Endoscopy and Department of General and Visceral Surgery, University of Freiburg, Germany, performed a retrospective study evaluating rebleeding, primary failure and mortality of patients, in whom OTSCs were used as first-line and second-line endoscopic treatment (FLET, SLET) of upper and lower gastrointestinal bleeding (GIB).

All patients with upper and lower GIB who underwent FLET and SLET with OTSCs between 04/2012 and 05/2016 were included. In addition, patients with upper GIB were categorized by complete Rockall risk score, and the data were used to calculate predictors of OTSC success and mortality.

A total of 93 patients (58 males, median age 72, range 19-98) with altogether 100 severe acute GIB lesions fulfilled the inclusion criteria. One patient had 3 OTSC applications, and five other patients had 2 OTSCs on different lesions. First-line OTSC treatment was performed in 61 cases and second line OTSC treatment in 42 cases. The mean hospital stay was 19.8 d (range 1-79). Primary hemostasis was achieved in 88% of cases (88/100). Clinical success (no in-hospital rebleeding) was achieved in 78% of cases (78/100). Primary failure was significantly lower when OTSCs were applied as FLET compared to SLET (4.9% vs 23%, P=0.0008). Patients with Rockall scores 7 and above had a significantly higher in-hospital mortality compared to those with scores <7 (35% vs 10%, P=0.034). No significant differences were observed in patients with scores < or 7 and above in rebleeding and rebleeding-associated mortality.

The authors concluded that the reduction of primary failure in endoscopic treatment of severe acute gastrointestinal bleeding was best achieved when OTSC was used for first line treatment. In this series, first line OTSC treatment seemed to be a predictor of successful reduction of rebleeding rates.

First-line endoscopic treatment with over-the-scope clips significantly improves the primary failure and rebleeding rates in high risk gastrointestinal bleeding: A single-center experience with 100 cases
Richter-Schrag HJ, Glatz T, Walker C, Fischer A, Thimme R (2016)
World J Gastroenterol 2016 Nov 7; 22(41): 0000-0000. ISSN 1007-9327 (print) ISSN 2219-2840 (online)