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CC BY 4.0 · Journal of Digestive Endoscopy 2023; 14(03): 135-143
DOI: 10.1055/s-0043-1774773
Research Article

Efficacy of Over-the-Scope Clips Compared to Standard Therapy for Nonvariceal Upper Gastrointestinal Bleeding—A Systematic Review and Meta-analysis of Randomized Trials

Suprabhat Giri 
1   Department of Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
,
Sidharth Harindranath
2   Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
,
Marko Kozyk
3   Department of Internal Medicine, Corewell Health William Beaumont University Hospital, Michigan, United States
,
Aditya Kale
4   Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Mumbai, Maharashtra, India
,
Vaneet Jearth
5   Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Sridhar Sundaram
4   Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Abstract

The current standard of treatment for nonvariceal upper gastrointestinal bleeding (NVUGIB) includes endoscopic hemostasis with either through-the-scope clips or thermal therapy. However, they may be associated with rebleeding, especially in high-risk ulcers. Over-the-scope clips (OTSC) have been demonstrated in multiple recent studies to be an effective measure for NVUGIB. We aimed to analyze the current literature on standard therapy with OTSC to manage NVUGIB. A meta-analysis was performed by pooling the data from randomized studies obtained from a comprehensive search of Medline, Embase, and Scopus from inception to February 2023. The outcomes analyzed included rates of persistent bleeding, rebleeding, mortality, and duration of hospitalization. A total of five studies were included in the final analysis. There was no significant difference in the risk of persistent bleeding between the groups, with a risk ratio (RR) of 0.29 (95% confidence interval [CI]: 0.07–1.27). The use of OTSC was associated with a significantly lower risk of 7-day and 30-day rebleeding compared with standard therapy with RR of 0.30 (95% CI: 0.16–0.59) and 0.42 (95% CI: 0.24–0.72), respectively. There was no difference in the risk of 30-day mortality or the duration of hospitalization. There was no change in the effect on subgroup analysis of studies using OTSC as first-line therapy. The use of OTSC can reduce the rebleeding rates after endoscopic hemostasis. However, they may not reduce the risk of persistent bleeding or mortality. Future studies are required on the cost-efficacy of this modality.

Keywords

upper gastrointestinal bleeding - peptic ulcer bleeding - over-the-scope clips - through-the scope clips - meta-analysis

Authors' Contributions

S.G. and S.H. conceptualized the study. S.G. and A.K. were involved in methodology. S.G., S.H., and M.K. contributed to formal analysis. A.K. and S.S. helped in Project administration. S.G., S.H., and V.J. were involved in visualization. S.G. helped in software. S.G., S.H., and V.J. validated the study. S.G., S.H., and M.K. wrote the original draft. S.G., S.H., V.J., and S.S. reviewed and edited the manuscript. All authors approved the final manuscript.




Publication History

Article published online:
09 October 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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