Download PDF
CC BY-NC-ND 4.0 · Endosc Int Open 2017; 05(09): E875-E882
DOI: 10.1055/s-0043-105496
Original article
Eigentümer und Copyright ©Georg Thieme Verlag KG 2017

Use of the over-the-scope-clip (OTSC) in non-variceal upper gastrointestinal bleeding in patients with severe cardiovascular comorbidities: a retrospective study

Edris Wedi
1   Department of Gastroenterology and Gastrointestinal Oncology, University Medical Centre Goettingen, Center of Interdisciplinary Endoscopy, Goettingen, Germany
2   Department of Gastroenterology, Nouvel Hôpital Civil, University Hospitals, Strasbourg, France
,
Daniel von Renteln
4   Division of Gastroenterology, Centre Hospitalier de l’Université de Montréal (CHUM), Research Centre CHUM (CRCHUM) Montreal, Quebec, Canada
,
Susana Gonzalez
3   Division of Gastroenterology, NYU Langone Medical Center, New York, New York, United States
,
Olena Tkachenko
5   Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, Oregon, United States
,
Carlo Jung
1   Department of Gastroenterology and Gastrointestinal Oncology, University Medical Centre Goettingen, Center of Interdisciplinary Endoscopy, Goettingen, Germany
2   Department of Gastroenterology, Nouvel Hôpital Civil, University Hospitals, Strasbourg, France
,
Sinan Orkut
1   Department of Gastroenterology and Gastrointestinal Oncology, University Medical Centre Goettingen, Center of Interdisciplinary Endoscopy, Goettingen, Germany
,
Victor Roth
1   Department of Gastroenterology and Gastrointestinal Oncology, University Medical Centre Goettingen, Center of Interdisciplinary Endoscopy, Goettingen, Germany
,
Selin Tumay
1   Department of Gastroenterology and Gastrointestinal Oncology, University Medical Centre Goettingen, Center of Interdisciplinary Endoscopy, Goettingen, Germany
,
Juergen Hochberger
1   Department of Gastroenterology and Gastrointestinal Oncology, University Medical Centre Goettingen, Center of Interdisciplinary Endoscopy, Goettingen, Germany
6   Division of Gastroenterology, Vivantes Klinikum in Friedrichshain, Teaching Hospital of Charité Humboldt University, Berlin, Germany
› Author Affiliations
Further Information

Publication History

submitted 18 November 2016

accepted after revision 13 February 2017

Publication Date:
12 September 2017 (online)

Also available at
   Permissions and Reprints

Abstract

Introduction The over-the-scope-clip (OTSC) can potentially overcome limitations of standard clips and achieve more efficient and reliable hemostasis. Data on OTSC use for non-variceal upper gastrointestinal bleeding (NVUGIB) in patients with cardiovascular comorbidities are currently limited.

Patients and methods We prospectively collected and retrospectively analyzed our database from February 2009 to September 2015 from all patients who underwent emergency endoscopy for high-risk NVUGIB in 2 academic centers and were treated with OTSC as first-line (n = 81) or second-line therapy (n = 19).

Results One hundred patients mean age 72 (range 27 – 97 years) were included in this study. Fifty-one percent (n = 51) had severe cardiovascular co-morbidity (ischemic heart disease, congestive heart failure, hypertension, valvular heart disease, peripheral arterial occlusive disease and atrial fibrillation) and 73 % (n = 73) were on antiplatelet or/and anticoagulation therapy. The median size of the treated ulcers was 3 cm (range 1 – 5 cm). In 94 % (n = 94) primary hemostasis with OTSC was achieved. Clinical long-term success during a mean 6-month follow-up without rebleeding was 86 % (n = 86).

Conclusions In this cohort OTSC was demonstrated to be a safe and effective first- or second-line treatment for NVUGIB in high-risk patients with cardiovascular disease and complex, large ulcers.

Meeting presentations: Annual Meeting of the German Society of Endoscopy (DEGBV) in Mannheim, Germany, March 17th–19th, 2016 and DDW 2016 in San Diego, United States

 

  • References

  • 1 Barkun AN, Bardou M, Kuipers EJ. et al. International consensus recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding. Annals of internal medicine 2010; 152: 101-113
    CrossrefPubMedGoogle Scholar
  • 2 Bakkevold KE. Time trends in incidence of peptic ulcer bleeding and associated risk factors in Norway 1985-2008. Clin Exp Gastroenterol 2010; 3: 71-77
    PubMedGoogle Scholar
  • 3 Loperfido S, Baldo V, Piovesana E. et al. Changing trends in acute upper-GI bleeding: a population-based study. Gastrointest Endosc 2009; 70: 212-224
    CrossrefPubMedGoogle Scholar
  • 4 Kang JY, Elders A, Majeed A. et al. Recent trends in hospital admissions and mortality rates for peptic ulcer in Scotland 1982-2002. Alimentary Pharmacol Ther 2006; 24: 65-79
    CrossrefPubMedGoogle Scholar
  • 5 Leontiadis GI, Molloy-Bland M, Moayyedi P. et al. Effect of comorbidity on mortality in patients with peptic ulcer bleeding: systematic review and meta-analysis. Am J Gastroenterol 2013; 108: 331-345 ; quiz 346
    CrossrefPubMedGoogle Scholar
  • 6 von Renteln D, Vassiliou MC, Rothstein RI. Randomized controlled trial comparing endoscopic clips and over-the-scope clips for closure of natural orifice transluminal endoscopic surgery gastrotomies. Endoscopy 2009; 41: 1056-1061
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Kirschniak A, Kratt T, Stuker D. et al. A new endoscopic over-the-scope clip system for treatment of lesions and bleeding in the GI tract: first clinical experiences. Gastrointest Endosc 2007; 66: 162-167
    CrossrefPubMedGoogle Scholar
  • 8 Haito-Chavez Y, Law JK, Kratt T. et al. International multicenter experience with an over-the-scope clipping device for endoscopic management of GI defects (with video). Gastrointest Endosc 2014; 80: 610-622
    CrossrefPubMedGoogle Scholar
  • 9 Baron TH, Song LM, Ross A. et al. Use of an over-the-scope clipping device: multicenter retrospective results of the first U.S. experience (with videos). Gastrointest Endosc 2012; 76: 202-208
    CrossrefPubMedGoogle Scholar
  • 10 Chan SM, Chiu PW, Teoh AY. et al. Use of the Over-The-Scope Clip for treatment of refractory upper gastrointestinal bleeding: a case series. Endoscopy 2014; 46: 428-431
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Manta R, Galloro G, Mangiavillano B. et al. Over-the-scope clip (OTSC) represents an effective endoscopic treatment for acute GI bleeding after failure of conventional techniques. Surg Endosc 2013; 27: 3162-3164
    CrossrefPubMedGoogle Scholar
  • 12 Skinner M, Gutierrez JP, Neumann H. et al. Over-the-scope clip placement is effective rescue therapy for severe acute upper gastrointestinal bleeding. Endoscop Int Open 2014; 2: E37-40
    PubMedGoogle Scholar
  • 13 Wedi E, Gonzalez S, Menke D. et al. One hundred and one over-the-scope-clip applications for severe gastrointestinal bleeding, leaks and fistulas. World J Gastroenterol 2016; 22: 1844-1853
    CrossrefPubMedGoogle Scholar
  • 14 Kyaw M, Tse Y, Ang D. et al. Embolization versus surgery for peptic ulcer bleeding after failed endoscopic hemostasis: a meta-analysis. Endoscop Int Open 2014; 2: E6-E14
    PubMedGoogle Scholar
  • 15 Lewis JD, Bilker WB, Brensinger C. et al. Hospitalization and mortality rates from peptic ulcer disease and GI bleeding in the 1990s: relationship to sales of nonsteroidal anti-inflammatory drugs and acid suppression medications. The Am J Gastroenterol 2002; 97: 2540-2549
    PubMedGoogle Scholar
  • 16 Martins NB, Wassef W. Upper gastrointestinal bleeding. Curr Opin Gastroenterol 2006; 22: 612-619
    PubMedGoogle Scholar
  • 17 Esrailian E, Gralnek IM. Nonvariceal upper gastrointestinal bleeding: epidemiology and diagnosis. Gastroenterol Clin North Am 2005; 34: 589-605
    CrossrefPubMedGoogle Scholar
  • 18 Lanas A, Wu P, Medin J. et al. Low doses of acetylsalicylic acid increase risk of gastrointestinal bleeding in a meta-analysis. Clin Gastroenterol Hepatol 2011; 9: 762-768 , e766
    CrossrefPubMedGoogle Scholar
  • 19 Laine L, Jensen DM. Management of patients with ulcer bleeding. Am J Gastroenterol 2012; 107: 345-360 ; quiz 361
    CrossrefPubMedGoogle Scholar
  • 20 Gralnek IM, Barkun AN, Bardou M. Management of acute bleeding from a peptic ulcer. N Engl J Med 2008; 359: 928-937
    CrossrefPubMedGoogle Scholar
  • 21 Sung JJ, Tsoi KK, Lai LH. et al. Endoscopic clipping versus injection and thermo-coagulation in the treatment of non-variceal upper gastrointestinal bleeding: a meta-analysis. Gut 2007; 56: 1364-1373
    CrossrefPubMedGoogle Scholar
  • 22 Albert JG, Friedrich-Rust M, Woeste G. et al. Benefit of a clipping device in use in intestinal bleeding and intestinal leakage. Gastrointest Endosc 2011; 74: 389-397
    CrossrefPubMedGoogle Scholar
  • 23 Naegel A, Bolz J, Zopf Y. et al. Hemodynamic efficacy of the over-the-scope clip in an established porcine cadaveric model for spurting bleeding. Gastrointest Endosc 2012; 75: 152-159
    CrossrefPubMedGoogle Scholar
  • 24 Hackett NJ, De Oliveira GS, Jain UK. et al. ASA class is a reliable independent predictor of medical complications and mortality following surgery. Int J Surg 2015; 18: 184-190
    CrossrefPubMedGoogle Scholar
  • 25 Elmunzer BJ, Young SD, Inadomi JM. et al. Systematic review of the predictors of recurrent hemorrhage after endoscopic hemostatic therapy for bleeding peptic ulcers. Am J Gastroenterol 2008; 103: 2625-2632 ; quiz 2633
    CrossrefPubMedGoogle Scholar
  • 26 Crooks CJ, West J, Card TR. Comorbidities affect risk of nonvariceal upper gastrointestinal bleeding. Gastroenterol 2013; 144: 1384-1393 , e1381–1382; quiz e1318–1389
    CrossrefPubMedGoogle Scholar
  • 27 Gralnek IM, Dumonceau JM, Kuipers EJ. et al. Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2015; 47: a1-a46
    Article in Thieme ConnectPubMedGoogle Scholar
  • 28 Manno M, Mangiafico S, Caruso A. et al. First-line endoscopic treatment with OTSC in patients with high-risk non-variceal upper gastrointestinal bleeding: preliminary experience in 40 cases. Surg Endoscop 2016; 30: 2026-2029
    CrossrefPubMedGoogle Scholar
  • 29 Hippisley-Cox J, Coupland C. Predicting risk of upper gastrointestinal bleed and intracranial bleed with anticoagulants: cohort study to derive and validate the QBleed scores. BMJ 2014; 349: g4606
    CrossrefPubMedGoogle Scholar
  • 30 Voermans RP, Le Moine O, von Renteln D. et al. Efficacy of endoscopic closure of acute perforations of the gastrointestinal tract. Clin Gastroenterol Hepatol 2012; 10: 603-608
    CrossrefPubMedGoogle Scholar