High efficacy of OTSC as first-line endoscopic treatment in patients with gastrointestinal bleeding: an italian multicentric experience in a large cohort of patients

Background and aim: The over-the-scope clip (OTSC) is a known endoscopic clipping device designed for tissue approximation, used for endoscopic closure of perforations, leaks, fistulas and for endoscopic hemostasis. Our aim was to evaluate the efficacy of OTSC as a first-line endoscopic treatment in patients with high-risk non-variceal gastrointestinal bleeding Material and methods: In a retrospective analysis of prospectively collected data in tertiary referral centers, patients underwent to emergency endoscopy for severe acute nonvariceal gastrointestinal bleeding were treated with OTSC as primary first-line therapy. The endoscopic procedures were performed in anaestesiologic-assisted deep sedation, by skilled operators. Technical and clinical success, rate of rebleding, blood infusion, days of hospitalization were recorded for each patient Results: From January 2014 to July 2017, we included 226 consecutive patients with mean age 68 years (range 28–89 years). Indications for OTSC treatment included, for the upper gastrointestinal tract, duodeno-jejunal ulcer Forrest 1a (n=35) and Forrest 1b (n=43), gastric ulcer Forrest 1a (n=26) and Forrest 1b (n=32), Mallory Weiss (n=19), Dieulafoy’s lesion (n=9), post gastric-ESD bleeding (n=14); for the lower gastrointestinal tract indications for OTSC treatment included post EMR bleeding (n=15), post ESD bleeding (n=12), traumatic rectal ulcer (n=2), colonic diverticulum (n=4); 15 patients with upper or lower gastrointestinal tract surgical anastomosis bleeding were also included. Technical success was achieved in cases 222/226 cases (98%). Primary haemostasis was achieved in 218/226 patients (96%). In theremaining 8 patients haemostasis was obtained with radiological vascular embolization (n=5) or surgery (n=3). Early re-bleeding occurred in 9 patients after 12–24 hours and it was treated with epinephrine injection with or without use of through the scope clips in case of minor oozing from the bleeding site (n=6) while radiological vascular embolization was required for major bleeding events (n=3). In these 9 patients median number of packed red cell units transfused was 2 U (1–3 U) whilst it was not needed in patients successfully treated with OTSC. Median length of total hospital stay of 4 days (3–11 days) was required in patients responsive to OTSC treatment. Bleeding related mortality rate was 6/226 (2.6%).