Endoscopic Tx of Upper GI Bleeds Using Large Over-the-Scope Haemoclips Reduces Rebleeding Rates by 85%
By Eric Ramos
SAN ANTONIO, Tex -- November 2, 2019 -- Among patients with non-variceal upper gastrointestinal (GI) bleeding, initial endoscopic treatment with a large over-the-scope haemocliping device (OTSC System) significantly reduced rebleeding rates, compared with patients who were treated with standard endoscopic haemostasis, according to a study presented here at the 2019 Annual Meeting of the American College of Gastroenterology (ACG).
The rebleeding rate was 85% lower among patients randomised to treatment with the OTSC System compared with patients who received standard endoscopic treatment.
“The OTSC system can capture larger amounts of tissue and larger underlying arteries than standard haemoclips, which improves endoscopic haemostasis of bleeding lesions,” explained Dennis Jensen, MD, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California.
For the double-blinded study, 49 patients from 2 medical centres who needed an emergency endoscopy due to peptic ulcers or Dieulafoy’s lesions were randomised 1:1 to receive standard endoscopic treatment or endoscopic treatment with the OTSC System. All patients received high-dose proton pump inhibitors after randomisation.
Patients randomised to standard endoscopy received haemostasis therapy for the focal GI lesions with injection of dilute epinephrine, thermal coagulation with multipolar electrocautery probe, and/or haemoclips.
In the OTSC group, once the endoscopic diagnosis was made, the endoscope was removed and affixed with the over-the-scope haemocliping device of appropriate size for the endoscope and the lesion in question. The endoscope was then re-introduced to the bleeding site. The stigmata of recent haemorrhage (SRH) was centred in the field of view and within the cap of the OTSC deployment device. The lesion and SRH was captured into the cap and the haemoclip was deployed by rotating the handle and thereby compressing the bleeding lesion and surrounding tissue for mechanical haemostasis. If initial deployment was unsuccessful, a second deployment was allowed.
The proportion of patients with 30 day rebleeding -- the primary endpoint -- was significantly higher among the 25 patients randomised to receive standard endoscopic treatment (28%) compared with the 24 patients randomised to treatment with OTSC (4.2%; P = .022).
“In patients with severe upper GI bleeding from peptic ulcers or Dieulafoy’s lesions, primary endoscopic treatment with a large over-the-scope hemoclip resulted in significantly lower rates of rebleeding and severe complications,” the authors concluded. “Results appear to relate to the device’s superior ability to obliterate arterial blood flow underneath SRH and thereby reduce lesion rebleeding.”
[Presentation title: Randomized Controlled Trial (RCT) of Over-the-Scope Clip (OTSC) as Initial Endoscopic Treatment of Severe Non-Variceal Upper Gastrointestinal Bleeding (NVUGIB). Abstract 8]