Over-The-Scope Clips (OTSC) versus Transarterial Angiographic Embolisation (TAE) as salvage therapy for refractory peptic ulcer bleeding - a propensity score matched analysis

Introduction Refractory bleeding from peptic ulcer is associated with substantial morbidity and mortality. Over-The-Scope clips (OTSC) have shown superiority to standard endoscopic treatment for recurrent bleeding, but a comparison to transarterial angiographic embolisation (TAE) does not exist so far.

Aims and methods In this retrospective, multicenter study, we report on one hundred twenty-eight patients treated with OTSC (n=66) or TAE (n=62) as salvage therapy for peptic ulcer bleeding refractory to standard endoscopic therapy between 2009-2019. Primary endpoint was clinical success, defined as successful hemostasis and absence of rebleeding within 7 days. Main secondary endpoints were adverse events, length of hospital and intensive care unit (ICU) stay, number of transfusions and mortality. Propensity score matching was used to adjust for differences in baseline characteristics.

Results There were no significant differences regarding age, Charlson comorbidity index, Rockall score, Helicobacter pylori status, ongoing anticoagulation, NSAID intake, primary hemostasis rate in first line therapy and number of endoscopic treatment attempts before salvage therapy. The majority of ulcers were located in the duodenal bulb (65% in OTSC group; 85.5% in the TAE group; p =0.014). The TAE group included significantly more FIa bleedings (38.7% vs. 19.7%, p =0.02). The proportion of FIb bleedings was significantly higher in the OTSC group (63.6% vs. 43.5%; p =0.03). In both groups, the proportion of patients with ulcer size > 20mm was similar (27.3% vs. 33.9%, p =0.48). Clinical success was by trend higher in the OTSC group (74.2% vs. 59.7%; p =0.09). Rebleeding rate during hospital stay was higher in the TAE group (27.4% vs 18.2%; p =0.29). In-hospital mortality was higher in the TAE group (9.1% vs. 22.6%; p =0.05). TAE patients stayed significantly longer in ICU (p =0.02). Overall adverse events were similar in both groups. The propensity score matching analysis confirmed these findings. Moreover, there was a statistically significant higher In-hospital mortality in patients treated with TAE (OR 5.52 {1.11-27.43}; p =0.048).

Conclusion OTSC treatment for refractory peptic ulcer bleeding shows comparable efficacy with lower mortality compared to TAE.

Publication History

Article published online:
08 September 2020