Over-the-Scope Clips Decrease Nonvariceal Upper GI Rebleeding Rates

Using over-the-scope clips (OTSC) to treat nonvariceal upper gastrointestinal bleeding (UGIB) is associated with significantly lower rebleeding risk when compared with standard of care, according to study findings published in Digestive Diseases and Sciences.

Prior studies have shown that OTSC is effective in treating nonvariceal UGIB and shows the potential to be more effective than the standard of care in reducing rebleeding. This systematic review and meta-analysis compared OTSC with the standard endoscopic intervention for first-line treatment for nonvariceal UGIB.

Only studies that compared OTSC with standard endoscopic treatments were included in the analysis. A total of 480 articles were identified and 11 articles were included in a meta-analysis following exclusion.

Researchers used the Cochrane tool to assess bias risk and the methodological index for nonrandomized studies (MINORS) criteria to determine the study quality.

The primary outcome was comparing rebleeding rates between the different treatments. The secondary outcomes were initial hemostasis, repeat endoscopy, vascular embolization use, need for surgery, and mortality. 

The rebleeding rate was significantly lower for the OTSC treatment group (7.7%) compared with the standard treatment group (16.4%) (risk ratio [RR], 0.58; 95% CI, 0.41-0.82; I²=0%).

Similar trends were observed for subgroup analysis including RCTs only, with the rate of rebleeding significantly lower for patients treated with OTSC (RR, 0.38; 95% CI, 0.20-0.70; I²=0%). Subgroup analysis with only observational studies showed no difference in rebleeding between treatments (RR, 0.71; 95% CI, 0.47-1.07; I²=0%). The subgroup analysis for patients with peptic ulcer disease (PUD) revealed that the rebleeding rate was lower in the OTSC group (RR, 0.51; 95% CI, 0.29-0.90; I²=0%).

For secondary outcomes, there were no significant differences between groups for initial hemostasis (RR, 1.05; 95% CI, 0.99-1.11), vascular embolization rates (RR, 0.93; 95% CI 0.40-2.13), and need for repeat endoscopy (RR, 0.78; 95% CI, 0.40-1.49).

Additionally, there were no significant differences observed for the 30-day readmission rate (RR, 0.59; 95% CI 0.17-2.01), need for surgery (RR, 0.81; 95% CI 0.29-2.28), and mortality (RR, 0.69; 95% CI 0.38-1.23).

Study limitations include differences in study methodology, including patients with various comorbidities, and differences in interventions across studies.

“Because of presence of fibrosis and granulation tissue in ulcers, OTSC are likely to work better than standard endoscopic modalities in patients with bleeding due to PUD,” the researchers wrote.