Efficacy of Over the Scope Clips in Management of High-risk Gastrointestinal Bleeding.Brandler J, Buttar N, Baruah A, Zeb M, Mehfooz A, Pophali P, Song LWK, AbuDayyeh B, Gostout C, Mara K, Dierkhising R. Clin Gastroenterol Hepatol. 2017 Jul 26 [Epub ahead of print]
BACKGROUND & AIMS:Standard endoscopic therapies do not control bleeding or produce complications in as many as 20% of patients with non-variceal gastrointestinal bleeding. Most bleeding comes from ulcers with characteristics such as high-risk vascular territories and/or large vessels. We evaluated the efficacy of using over the scope clips (OTSCs) as primary or rescue therapy for patients with bleeding from lesions that have a high-risk for adverse outcomes.
METHODS:We performed a retrospective analysis of data from 67 patients with gastrointestinal bleeding from high-risk lesions who were treated with OTSC as primary (n=49) or rescue therapy (n=18) at a quaternary center, from December 2011 through February 2015. The definition of high-risk lesions was those situated in area of a major artery and greater than 2 mm in diameter and/or a deep penetrating, excavated, fibrotic ulcer with high risk stigmata, where a perforation could not be ruled out or thermal therapy would cause perforation, or those that could not be treated by standard endoscopy. Clinical severity was determined based on Rockall score and modified Blatchford score. Our primary outcome was incidence of re-bleeding within 30 days after OTSC placement. We assessed risk factors for re-bleeding using univariate hazard models followed by multivariable analysis.RESULTS:Of the 67 patients, 47 (70.1%) remained free of re-bleeding at 30 days after OTSC placement. We found no difference in proportions of patients with re-bleeding who received primary or rescue therapy (hazard ratio, 0.639; 95% CI, 0.084-4.860; P=.6653). Only 9 re-bleeding events were clearly linked to OTSC and required intervention, indicating an OTSC success rate of 81.3%. We found no significant associations between re-bleeding and clinical scores. However, on multivariable analysis, patients with coronary artery disease had a higher risk of re-bleeding after OTSC independent of international normalized ratio and anti-platelet use (hazard ratio, 7.30; P=.0002).CONCLUSION:In a retrospective analysis of 67 patients with bleeding from high-risk gastrointestinal lesions, we found OTSC to prevent re-bleeding in more than 80% of cases. In the past, these lesions were treated with surgical or radiologic interventions. Patients with coronary artery disease have an increased risk of re-bleeding after OTSC, suggesting the need for escalated therapies.