REVIEW   

Minerva Gastroenterologica e Dietologica 2019 March;65(1):70-6

DOI: 10.23736/S1121-421X.18.02513-8

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Over-the-scope-clips as primary and rescue therapy for non-variceal gastrointestinal bleeding: a systematic review and meta-analysis

Andrew OFOSU ¹, Daryl RAMAI ², Febin JOHN ¹, Mohammed BARAKAT ¹, Tagore SUNKARA ¹, Santosh SHARMA ², Vinaya GADUPUTI ³, Douglas G. ADLER ⁴ ✉, Madhavi REDDY ¹

¹ Division of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Clinical Affiliate of the Mount Sinai Hospital, Brooklyn, NY, USA; ² Department of Medicine, The Brooklyn Hospital Center, Clinical Affiliate of the Mount Sinai Hospital, Brooklyn, NY, USA; ³ Department of Gastroenterology and Hepatology, St. Barnabas Hospital, Bronx, NY, USA; ⁴ Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, UT, USA

INTRODUCTION: Endoscopic hemostasis in patients with non-variceal bleeding (NVGIB) with standard therapy has improved outcomes. However, persistent bleeding and re-bleeding continues to drive morbidity and mortality. Use of over-the-scope clips (OTSC) is an emerging treatment modality for managing gastrointestinal (GI) bleeding. We performed a systematic review and meta-analysis to evaluate the ability of OTSC to achieve primary hemostasis and re-bleeding rates as primary therapy and rescue endoscopic interventions in patients with NVGIB.
EVIDENCE ACQUISITION: We searched articles in PubMed, Ovid Medline In- Process & Other Non-Indexed Citations, Embase, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus from inception to July 2017 using keywords such as “OTSC” and “NVGIB.”
EVIDENCE SYNTHESIS: A total of 16 studies which involved 475 patients met the inclusion criteria. 288 patients were treated with OTSC as primary therapy while 187 patients were treated with OTSC as rescue therapy. Primary hemostasis rate achieved with primary endoscopic therapy with OTSC was 0.93 (95% CI: 0.89-0.96). Similarly, primary hemostasis rate achieved with rescue endoscopic therapy with OTSC was 0.91 (95% CI: 0.84-0.95). Re-bleeding rates after primary endoscopic therapy with OTSC was 0.21 (95% CI:0.08-0.43) and 0.25 (95% CI:0.17-0.34) with rescue therapy. There was a decreased risk of re-bleeding in patients treated with OTSC as primary therapy versus rescue therapy. RR=0.52 (95% CI: 0.31-0.89).
CONCLUSIONS: This meta-analysis demonstrates success on the use of OTSC as primary and rescue therapy in the management of NVGIB. Further trials should clarify the ideal setting for the use of OTSC and assess the cost of these devices as compared to standard therapy.

KEY WORDS: Gastrointestinal hemorrhage - Hemostasis - Endoscopy