Endoscopy 2020; 52(S 01): S58
DOI: 10.1055/s-0040-1704181
ESGE Days 2020 oral presentations
Thursday, April 23, 2020 16:30 – 18:00 Removing doubt from the red-out: Liffey Meeting Room 1 Upper GI hemostasis
© Georg Thieme Verlag KG Stuttgart · New York

SINGLE OTSC CLIP IS SUPERIOR COMPARED TO STANDARD THERAPY FOR ACUTE UPPER GI BLEEDING IN LARGE UK SERIES- IS IT TIME TO CHANGE?

I Rahman
University Hospital Southampton NHS Foundation Trust, Southampton Interventional Endoscopy Unit, Southampton, United Kingdom
,
P Duarte
University Hospital Southampton NHS Foundation Trust, Southampton Interventional Endoscopy Unit, Southampton, United Kingdom
,
T Hollingworth
University Hospital Southampton NHS Foundation Trust, Southampton Interventional Endoscopy Unit, Southampton, United Kingdom
,
P Boger
University Hospital Southampton NHS Foundation Trust, Southampton Interventional Endoscopy Unit, Southampton, United Kingdom
,
P Patel
University Hospital Southampton NHS Foundation Trust, Southampton Interventional Endoscopy Unit, Southampton, United Kingdom
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

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Aims To determine whether the use of the OTSC was associated with lower upper GI haemorrhage rebleeding rates and mortality in the UK.

Methods Consecutive episodes of upper GI haemorrhage treated with the OTSC were identified from a prospective database in a UK tertiary centre over a 3-year period. Treatment with OTSC was opted for patients with high risk features or failed conventional endoscopic therapy. Over the same time period, all patients with upper GI haemorrhage treated with standard endoscopic therapy were retrospectively identified, and a propensity score-matched cohort was generated. Patient demographics, 7 day re-bleeding rate, 30 day re-bleeding rate and 30 day mortality rates were compared. T-test and Pearson’s Chi-square test were used as appropriate.

Results 617 episodes of upper GI haemorrhage were identified requiring endoscopic intervention. Of these 71 high risk lesions were treated with the OTSC and 89 high risk lesions with standard endoscopic therapy in the matched control group. The sites of lesions treated with the OTSC included oesophagus (10%), stomach (22%) and duodenum (68%). The lesions were described as forest 1a-18%, 1b-33%, 2a-32%, 2b-17%. Pathology included ulcers (78.9%), Mallory-Weiss tears (9.6%) Dieulafoy (7.0%) post-angiographic coil ulcer (1.4%) post-EMR (1.4%) anastomotic bleed (1.4%).

Compared to the control group, the OTSC group had lower 7-day re-bleeding rate (19.3% vs 2.8%, p< 0.01) and a lower 30-day re-bleeding rate (25.0% vs 7.0%, p< 0.01). There was a trend toward reduction in all-cause mortality in the OTSC group (14.8% vs 8.5%, p=0.20) but a significantly lower haemorrhage related mortality in the OTSC group (4.5% vs 1.4%, p=0.02).

Conclusions This is one of the largest series of patients treated with OTSC for upper GI haemorrhage, demonstrating a significant reduction in both early and late rebleeding in addition to haemorrhage related mortality and thus needs to part of the treatment armamentarium.