Subscribe to RSS
Efficacy and safety of over-the-scope clips for gastrointestinal bleeding: a systematic review and meta-analysis
submitted 12 February 2019
accepted after revision 04 July 2019
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.
- 1 Jairath V, Barkun AN. Improving outcomes from acute upper gastrointestinal bleeding. Gut 2012; 61: 1246-1249
- 2 Laine L, Yang H, Chang S. et al. Trends for incidence of hospitalization and death due to GI complications in the United States from 2001 to 2009. Am J Gastroenterol 2012; 107: 1190-1195
- 3 Marmo R, Rotondano G, Piscopo R. et al. Dual therapy versus monotherapy in the endoscopic treatment of high-risk bleeding ulcers: a meta-analysis of controlled trials. Am J Gastroenterol 2007; 102: 279-289
- 4 Greenspoon J, Barkun A, Bardou M. et al. Management of patients with nonvariceal upper gastrointestinal bleeding. Clin Gastroenterol Hepatol 2012; 10: 234-239
- 5 Kirschniak A, Kratt T, Stüker D. et al. A new endoscopic over-the-scope clip system for treatment of lesions and bleeding in the GI tract: first clinical experiences. Gastrointest Endosc 2007; 66: 162-167
- 6 von Renteln D, Vassiliou MC, Rothstein RI. Randomized controlled trial comparing endoscopic clips and over-the-scope clips for closure of natural orifice transluminal endoscopic surgery gastrotomies. Endoscopy 2009; 41: 1056-1061
- 7 Gralnek IM, Dumonceau JM, Kuipers EJ. et al. Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2015; 47: 1-46
- 8 Schmidt A, Golder S, Goetz M. et al. Over-the-scope clips are more effective than standard endoscopic therapy for patients with recurrent bleeding peptic ulcers. Gastroenterology 2018; 155: 674-686
- 9 Liberati A, Altman DG, Tetzlaff J. et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 2009; 6: e1000100
- 10 Wallace BC, Dahabreh IJ, Trikalinos TA. et al. Closing the gap between methodologists and end-users: R as a computational back-end. J Stat Softw 2012; 49 DOI: 10.18637/jss.v049.i05.
- 11 Liu J, Saltzman J. Endoscopic hemostasis treatment: how should you perform it?. Can J Gastroenterol 2009; 23: 481-483
- 12 Sung J, Tsoi K, Lai L. et al. Endoscopic clipping versus injection and thermo-coagulation in the treatment of non-variceal upper gastrointestinal bleeding: a meta-analysis. Gut 2007; 56: 1364-1373
- 13 Ofosu A, Ramai D, John F. et al. Over-the-scope-clips as primary and rescue therapy for non-variceal gastrointestinal bleeding: a systematic review and meta-analysis. Minerva Gastroenterol Dietol 2019; 65: 70-76
- 14 Richter-Schrag H, Glatz T, Walker C. et al. 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. World J Gastroenterol 2016; 22: 9162
- 15 Skinner M, Gutierrez JP, Neumann H. et al. Over-the-scope clip placement is effective rescue therapy for severe acute upper gastrointestinal bleeding. Endosc Int Open 2014; 2: E37-40
- 16 Goenka M, Rai V, Goenka U. et al. Endoscopic management of gastrointestinal leaks and bleeding with the over-the-scope clip: a prospective study. Clin Endosc 2017; 50: 58-63
- 17 Manno M, Mangiafico S, Caruso A. et al. First-line endoscopic treatment with OTSC in patients with high-risk non-variceal upper gastrointestinal bleeding: preliminary experience in 40 cases. Surg Endosc 2016; 30: 2026-2029
- 18 Albert J, Friedrich-Rust M, Woeste G. et al. Benefit of a clipping device in use in intestinal bleeding and intestinal leakage. Gastrointest Endosc 2011; 74: 389-397
- 19 Repici A, Arezzo A, De Caro G. et al. Clinical experience with a new endoscopic over-the-scope clip system for use in the GI tract. Dig Liver Dis 2009; 41: 406-410
- 20 Kirschniak A, Subotova N, Zieker D. et al. The over-the-scope clip (OTSC) for the treatment of gastrointestinal bleeding, perforations, and fistulas. Surg Endosc 2011; 25: 2901-2905
- 21 Brandler J, Baruah A, Zeb M. et al. Efficacy of over-the-scope clips in management of high-risk gastrointestinal bleeding. Clin Gastroenterol Hepatol 2018; 16: 690-696.e1
- 22 Lamberts R, Koch A, Binner C. et al. Use of over-the-scope clips (OTSC) for hemostasis in gastrointestinal bleeding in patients under antithrombotic therapy. Endosc Int Open 2017; 5: E324-E330
- 23 Wedi E, von Renteln D, Gonzalez S. et al. Use of the over-the-scope-clip (OTSC) in non-variceal upper gastrointestinal bleeding in patients with severe cardiovascular comorbidities: a retrospective study. Endosc Int Open 2017; 5: E875-E882
- 24 Wedi E, von Renteln D, Jung C. et al. Treatment of acute colonic diverticular bleeding in high risk patients, using an over-the-scope clip: a case series. Endoscopy 2016; 48 (Suppl. 01) E383-E385
- 25 Soetikno R, Asokkumar R, Sim D. et al. Use of the over-the-scope clip to treat massive bleeding at the transitional zone of the anal canal: a case series. Gastrointest Endosc 2016; 84: 168-172
- 26 Mönkemüller K, Peter S, Toshniwal J. et al. Multipurpose use of the ‘bear claw’ (over-the-scope-clip system) to treat endoluminal gastrointestinal disorders. Dig Endosc 2014; 26: 350-357
- 27 Manta R, Galloro G, Mangiavillano B. et al. Over-the-scope clip (OTSC) represents an effective endoscopic treatment for acute GI bleeding after failure of conventional techniques. Surg Endosc 2013; 27: 3162-3164
- 28 Chan S, Chiu P, Teoh A. et al. Use of the over-the-scope clip for treatment of refractory upper gastrointestinal bleeding: a case series. Endoscopy 2014; 46: 428-431
- 29 Nishiyama N. Efficacy and safety of over-the-scope clip: including complications after endoscopic submucosal dissection. World J Gastroenterol 2013; 19: 2752
- 30 Baron TH, Song LM, Ross A. et al. Use of an over-the-scope clipping device: multicenter retrospective results of the first U.S. experience. Gastrointest Endosc 2012; 76: 202-208
- 31 Asokkumar R, Soetikno R, Sanchez-Yague A. et al. Use of over-the-scope-clip (OTSC) improves outcomes of high-risk adverse outcome (HR-AO) non-variceal upper gastrointestinal bleeding (NVUGIB). Endosc Int Open 2018; 6: E789-E796
- 32 Manta R, Mangiafico S, Zullo A. et al. First-line endoscopic treatment with over-the-scope clips in patients with either upper or lower gastrointestinal bleeding: a multicenter study. Endosc Int Open 2018; 6: E1317-E1321