Over-The-Scope Clips (OTSC©) Versus Surgery for Refractory Peptic Ulcer Bleeding

A Kuellmer; T Mangold; D Bettinger; L Maruschke; A Wannhoff; K Caca; E Wedi; C Jung; T Kleemann; T Schulz; R Thimme; A Schmidt

doi:10.1055/s-0041-1724518

Endoscopy, Table of Contents

Endoscopy 2021; 53(S 01): S102
DOI: 10.1055/s-0041-1724518

Abstracts | ESGE Days

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Over-The-Scope Clips (OTSC©) Versus Surgery for Refractory Peptic Ulcer Bleeding

Authors

A Kuellmer

¹University of Freiburg, Faculty of Medicine, Department of Medicine II, Medical Center Freiburg, Freiburg, Germany
T Mangold

¹University of Freiburg, Faculty of Medicine, Department of Medicine II, Medical Center Freiburg, Freiburg, Germany
D Bettinger

¹University of Freiburg, Faculty of Medicine, Department of Medicine II, Medical Center Freiburg, Freiburg, Germany

²University of Freiburg, Berta-Ottenstein-Programme, Freiburg, Germany
L Maruschke

³University of Freiburg, Faculty of Medicine, Department of Radiology, Freiburg, Germany
A Wannhoff

⁴Hospital Ludwigsburg, Department of Internal Medicine and Gastroenterology, Ludwigsburg, Germany
K Caca

⁴Hospital Ludwigsburg, Department of Internal Medicine and Gastroenterology, Ludwigsburg, Germany
E Wedi

⁵Sana Klinikum Offenbach, Medizinische Klinik II/IV, Offenbach, Germany
C Jung

⁶University Medical Center Göttingen, Department of Gastroenterology and Gastrointestinal Oncology, Göttingen, Germany
T Kleemann

⁷Carl-Thiem-Klinikum Cottbus, Medinische Klinik IV, Cottbus, Germany
T Schulz

⁸Carl-Thiem-Klinikum Cottbus, Institut für Radiologie, Cottbus, Germany
R Thimme

¹University of Freiburg, Faculty of Medicine, Department of Medicine II, Medical Center Freiburg, Freiburg, Germany
A Schmidt

¹University of Freiburg, Faculty of Medicine, Department of Medicine II, Medical Center Freiburg, Freiburg, Germany

Abstract

Full Text

Aims Surgery and Transcatheter arterial embolization are considered standard treatment of peptic ulcer bleeding (PUB) refractory to endoscopic hemostasis. Over-The-Scope clips (OTSC) have shown superiority to standard endoscopic treatment but a comparison with surgery has not been performed, yet.

Methods In this retrospective study, 103 patients with refractory peptic ulcer bleeding treated either with OTSC (n = 66) or surgery (n = 37) between 2009-2019 at four academic centers were analyzed. Primary endpoint was clinical success defined as successful hemostasis and absence of rebleeding within 7 days and in-hospital mortality. Main secondary endpoints were overall and procedure-related adverse events, length of hospital and intensive care unit stay and number of transfusions. Univariate and multivariate logistic regression was performed for analysis of risk factors for mortality.

Results Baseline characteristics were similar in both groups regarding age, comorbidities, number of prior hemostasis attempts, ulcer size >20mm, and localization. The surgical group included significantly more Forrest Ia bleedings (64.9 % vs.19.7 % p = 0.001) and had more patients in shock (78.1 % vs. 43.9 %: p = 0.002).

Clinical success was similar in both groups (OTSC: 74.2 % vs surgery: 83.8 %; p = 0.329). In-hospital mortality was significantly higher in the surgical group (35.1 % vs. 9.1 %; p = 0.002) as well as stay on the ICU (7.1 vs. 18.8 days; p < 0.001), number of blood transfusions (9.4 vs. 19.9; p < 0.001), and complications arising from re-therapy after failure of OTSC or surgical treatment (37.5 % vs. 4.5 %; p < 0.001). Univariate and multivariate logistic regression confirmed complications after re-therapy as main risk factor for in-hospital mortality.

Conclusions OTSC treatment for refractory peptic ulcer bleeding shows comparable efficacy to surgery and a significantly reduced mortality. Complications following surgical treatment are responsible for this difference as shown in univariate and multivariate logistic regression.

Citation: Kuellmer A, Mangold T, Bettinger D et al. eP17 OVER-THE-SCOPE CLIPS (OTSC©) VERSUS SURGERY FOR REFRACTORY PEPTIC ULCER BLEEDING. Endoscopy 2021; 53: S102.