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DOI: 10.1055/s-0041-1724453
Treatment Of Duodenal Ulcer Bleeding - Efficacy Of Traumatic and Atraumatic Over-The-Scope-Clips (OTSC) – A Multicenter Retrospective Analysis
Aims The over-the-scope-clip (OTSC) substantially improved the endoscopic armamentarium for the treatment of severe gastrointestinal bleeding and can potentially overcome limitations of standard clips. Recent data indicated superiority of OTSC in hemostasis as first and second line therapy. However, the impact of the OTSC design (traumatic (-t) or atraumatic (-a) type) in particular in duodenal ulcer bleeding has not been analyzed thus far.
Methods Retrospective analysis of a prospective collected database from 2009 until 2020 of 6 German endoscopic centers. All patients who underwent emergency endoscopy and were treated by OTSC for duodenal ulcer bleeding were included to the analysis. Proportions of OTSC-t and OTSC-a were analyzed by chi-square-test, Mann-Whitney-U- or Students’ t-test.
Results 173 patients (93 OTSC-a, 80 OTSC-t) were included to the final analysis. The baseline characteristics age (71.2 y vs. 71.6 y, p=0.255), gender (male gender: 69.9 % vs. 67.5 %, p=0.735), anticoagulant therapy (32.9 % vs. 43.0 %, p=0.176) and Rockall-Score (7.2 vs. 7.4, p=0.917) were comparable between both groups. However, OTSC-a group showed significantly less active bleeding ulcers (Forrest Ia/b) than OTSC-t group (51.1 % vs. 62.5 %, p=0.020). OTSC-t was more often use as first-line treatment (95 % vs. 77.8 %, p=0.004). Initial bleeding hemostasis (OTSC-a: 93.5 %, OTSC-t: 90 %, p=0.421) or bleeding-associated mortality (OTSC-a: 3.2 %, OTSC-t: 7.8 %, p=0.125) were not significantly different between both groups but OTSC-t revealed a dramatically higher rate of rebleeding (37.2 % vs. 6.5 %, p<0.001).
Conclusions OTSC-a should be the standard of care for duodenal ulcer bleeding if the endoscopist aims for an over-the-scope-clip.
Citation: Hollenbach M, Schmidt A, Decker A et al. OP196 TREATMENT OF DUODENAL ULCER BLEEDING - EFFICACY OF TRAUMATIC AND ATRAUMATIC OVER-THE-SCOPE-CLIPS (OTSC) – A MULTICENTER RETROSPECTIVE ANALYSIS. Endoscopy 2021; 53: S81.
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Publication History
Article published online:
19 March 2021
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