Are Over-the-Scope Clips Superior to Other Methods of Hemostasis?
Von

Are Over-the-Scope Clips Superior to Other Methods of Hemostasis?

Vanessa M. Shami, MD, FASGE, reviewing Bapaye J, et al. Gastrointest Endosc 2022 Jul 5.

Nonvariceal upper gastrointestinal bleeding (NVUGIB) is potentially life-threatening and a common cause of hospitalization. Endoscopy is the procedure of choice for the evaluation and management of UGIB. Hemostatic tools such as the over-the-scope clip (OTSC) have evolved over the past decade. However, it is unclear whether this device is superior to standard therapies in achieving and maintaining hemostasis for UGIB. This systematic review and meta-analysis compared OTSCs versus standard therapy (STD) for NVUGIB. 

The study included 914 patients from 10 studies (4 randomized controlled trials) who presented with NVUGIB. OTSC was used to treat 431 patients, and STD treated 483 patients. 

The 7-day and 30-day rebleeding rates were lower in patients treated with OTSC versus STD (risk ratio [RR], 0.41; 95% confidence interval [CI], 0.24-0.68; I2=0% and RR, 0.46; 95% CI, 0.31-0.65; I2=0%, respectively). Additionally, clinical success rates were higher with OTSC than with STD (RR, 1.36; 95% CI, 1.06-1.75), and the mean procedure time was shorter in the OTSC group than in the STD group by 6.62 minutes (95% CI, 2.58-10.67). There was no statistically significant difference in mortality or length of hospitalization between the OTSC and STD groups.

Vanessa M. Shami, MD, FASGE

COMMENT

Although mortality rates and length of hospital stay were the same for the two groups regardless of the hemostatic modality used, OTSC showed promise with lower 7-day and 30-day rebleeding rates, higher clinical success rates, and shorter procedure times compared with standard therapy. As the authors thoughtfully state, a cost analysis is worth performing, and further randomized trials are needed to validate these results.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

CITATION(S)

Bapaye J, Chandan S, Naing LY, et al. A systematic review and meta-analysis of safety and efficacy of over the scope clips versus standard therapy for high-risk non-variceal upper gastrointestinal bleeding. Gastrointest Endosc 2022 Jul 5. (Epub ahead of print) (https://doi.org/10.1016/j.gie.2022.06.032)

Ähnliche Beiträge

VOR
Nach oben scrollen