Endoscopy 2019; 51(10): 941-949
DOI: 10.1055/a-0994-4361
Review
© Georg Thieme Verlag KG Stuttgart · New York

Efficacy and safety of over-the-scope clips for gastrointestinal bleeding: a systematic review and meta-analysis

Viveksandeep Thoguluva Chandrasekar
1   Department of Gastroenterology and Hepatology, University of Kansas School of Medicine, Kansas City, Kansas, United States
,
Madhav Desai
1   Department of Gastroenterology and Hepatology, University of Kansas School of Medicine, Kansas City, Kansas, United States
,
Muhammad Aziz
2   Department of Internal Medicine, University of Kansas School of Medicine, Kansas City, Kansas, United States
,
Harsh K. Patel
3   Department of Gastroenterology and Hepatology, Veteran Affairs Medical Center, Kansas City, Missouri, United States
,
Venkata Subhash Gorrepati
4   Department of Gastroenterology and Hepatology, Penn State Hershey Medical Center, Hershey, Pennsylvania, United States
,
Ramprasad Jegadeesan
1   Department of Gastroenterology and Hepatology, University of Kansas School of Medicine, Kansas City, Kansas, United States
,
Tarun Rai
3   Department of Gastroenterology and Hepatology, Veteran Affairs Medical Center, Kansas City, Missouri, United States
,
Anjana Sathyamurthy
3   Department of Gastroenterology and Hepatology, Veteran Affairs Medical Center, Kansas City, Missouri, United States
,
Alberto Murino
5   Department of Gastroenterology and Hepatology, The Royal Free Hospital and University College London, London, United Kingdom
,
Cesare Hassan
6   Department of Gastroenterology and Hepatology, Nuovo Regina Margherita Hospital, Digestive Endoscopy Unit, Rome, Italy
,
Alessandro Repici
7   Department of Gastroenterology and Hepatology, Humanitas Clinical and Research Center and Humanitas University, Digestive Endoscopy Unit, Division of Gastroenterology, Rozzano, Italy
,
Prateek Sharma
3   Department of Gastroenterology and Hepatology, Veteran Affairs Medical Center, Kansas City, Missouri, United States
› Author Affiliations
Further Information

Publication History

submitted 12 February 2019

accepted after revision 04 July 2019

Publication Date:
30 August 2019 (online)

Background The over-the-scope clip (OTSC) has been increasingly utilized for the management of gastrointestinal (GI) bleeding. Limited efficacy data are currently available from large-scale studies.

Methods An electronic database search was conducted for eligible articles using OTSCs for hemostasis in GI bleeding. The primary outcome was the rate of definitive hemostasis after primary hemostasis and without rebleeding at follow-up. Secondary outcomes were: primary technical success, primary clinical success, rebleeding, and failure rates. Pooled rates were expressed as proportions of patients with events over total patients, 95 % confidence limits (CI) with heterogeneity, and P values of < 0.05 for significance.

Results A total of 21 studies (n = 851) were analyzed (62.2 % males), with a median patient age of 69.7 years. The definitive hemostasis rate was 87.8 % (95 %CI 83.7 % – 92 %) after a median follow-up of 56 days. The OTSC was successfully deployed in 97.8 % of patients (95 %CI 96.7 % – 98.9 %) and the primary clinical success rate was 96.6 % (95 %CI 95.1 % – 98.2 %). Rebleeding was seen in 10.3 % of patients (95 %CI 6.5 % – 14.1 %). The failure rate of OTSCs was 9 % (95 %CI 5.2 % – 12.8 %) when used as first-line treatment and 26 % (95 %CI 16.1 % – 36.0 %) when used as second-line treatment.

Conclusion This systematic review showed high rates of definitive hemostasis, technical success, and clinical success, along with low rebleeding rates when OTSCs were used for the treatment of GI bleeding. The lack of randomized controlled trials of OTSC vs. other therapies makes comparison with conventional treatment difficult.

Supplementary material