Safety and efficacy of over-the-scope clips versus standard therapy for high-risk nonvariceal upper GI bleeding: systematic review and meta-analysis

Post written by Jay Bapaye, MD, from the Department of Internal Medicine, Rochester General Hospital, Rochester, New York, USA.


This study compared the safety and efficacy of over-the-scope clips (OTSCs) and standard therapy for high-risk nonvariceal upper GI bleeding (NVUGIB).

Upper GI bleeding carries a high risk of morbidity and mortality. Endoscopic therapy aims at achieving effective hemostasis and preventing rebleeding. Therapy with cautery and hemoclips continues to have high rebleeding rates, especially in high-risk NVUGIB.

Recent studies have evaluated the efficacy of OTSCs for NVUGIB. Therefore, a systematic review and meta-analysis comparing OTSCs and standard therapy for high-risk NVUGIB was expected to inform clinical practice in this field.

Based on our meta-analysis of 10 studies with 914 patients, we made a few key observations. The rebleeding rates at 7 days and 30 days were significantly lower among patients treated with OTSCs. The risk reduction for rebleeding was approximately 50% to 60%.

In the OTSC group, clinical success rates defined as intraprocedural hemostasis with prevention of rebleeding were significantly higher, and mean procedure time was shorter. Mortality was comparable in both groups. However, sensitivity analysis revealed that the exclusion of 1 study showed that mortality rates were significantly lower in the OTSC group.

Further studies could focus on the efficacy of OTSCs based on the location of the GI bleeding.


Graphical Abstract

Read the full article online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

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