Over-the-scope clip beneficial for nonvariceal upper gastrointestinal bleeding

For patients with bleeding from some nonvariceal upper gastrointestinal causes, over-the-scope clips (OTSC) may be better than standard treatment for reducing the risk for further bleeding, according to a study published online March 7 in the Annals of Internal Medicine.

James Y. W. Lau, M.D., from the Chinese University of Hong Kong, and colleagues compared OTSCs to standard endoscopic hemostatic treatments in the control of bleeding from nonvariceal upper gastrointestinal causes during a 30-day period. A total of 190 adult patients from university teaching hospitals in Hong Kong, China, and Australia were randomly assigned to standard hemostatic treatment or OTSC (97 and 93 patients, respectively).

The researchers found that the 30-day probability of further bleeding was 14.6 and 3.2 percent in the standard treatment and OTSC groups, respectively. Failure to control bleeding after assigned endoscopic treatment occurred in six patients undergoing standard treatment and one patient in the OTSC group; 30-day recurrent bleeding occurred in eight and two patients, respectively; and the need for further interventions occurred in eight and two patients, respectively.

Thirty-day mortality occurred in four and two patients, respectively. The event rate was 15.6 and 6.5 percent in the standard and OTSC groups, respectively, in a post-hoc analysis with a composite end point of failure to successfully apply assigned treatment and further bleeds.

"In conclusion, OTSCs, when successfully applied, may be better than standard endoscopic treatment as the first endoscopic hemostatic therapy for high-risk nonvariceal lesions," the authors write. "The primary use of OTSCs may find a role in the treatment of ulcers predicted to fail standard endoscopic treatment."

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