Comparison between traumatic and atraumatic over-the-scope clips in patients with duodenal ulcer bleeding: a retrospective analysis with propensity score-based matching.

Gastrointest Endosc

Division of Gastroenterology, Gastrointestinal Oncology and Interventional Endoscopy, Sana Clinic Offenbach, Offenbach, Germany; Clinic for Gastroenterology, Gastrointestinal Oncology and Endocrinology, University of Göttingen, Göttingen, Germany.

Published: July 2023

AI Article Synopsis

  • OTSCs (over-the-scope clips) enhance the treatment of severe gastrointestinal bleeding and may outperform standard clips, but the effectiveness of different OTSC designs (traumatic vs. atraumatic) for duodenal ulcer bleeding hasn't been previously studied.
  • A study analyzed data from 6 German centers over 11 years, involving 173 patients with duodenal ulcer bleeding treated with OTSCs, comparing outcomes between the two types.
  • Results indicated no significant difference in initial hemostasis or mortality; however, the traumatic OTSCs led to a much higher rate of recurrent bleeding and greater need for blood transfusions, suggesting atraumatic OTSCs are the better option for treatment.

Article Abstract

Background And Aims: Over-the-scope clips (OTSCs) substantially improved the endoscopic armamentarium for the treatment of severe GI bleeding and can potentially overcome limitations of standard clips. Data indicate a superiority of OTSCs in hemostasis as first- and second-line therapy. However, the impact of the OTSC designs, in particular the traumatic (-t) or atraumatic (-a) type, in duodenal ulcer bleeding has not been analyzed so far.

Methods: This was a retrospective analysis of a prospective collected database from 2009 to 2020 of 6 German endoscopic centers. All patients who underwent emergency endoscopy and were treated using an OTSC for duodenal ulcer bleeding were included. OTSC-t and OTSC-a patients were compared by the Fisher exact test, χ test, or Mann-Whitney U test as appropriate. A propensity score-based 1:1 matching was performed to obtain equal distribution of baseline characteristics in both groups.

Results: The entire cohort comprised 173 patients (93 OTSC-a, 80 OTSC-t). Age, gender, anticoagulant therapy, Rockall score, and treatment regimen had similar distributions in the 2 groups. However, the OTSC-t group showed significantly more active bleeding ulcers (Forrest Ia/b). Matching identified 132 patients (66 in both groups) with comparable baseline characteristics. Initial bleeding hemostasis (OTSC-a, 90.9%; OTSC-t, 87.9%; P = .82) and 72-hour mortality (OTSC-a, 4.5%; OTSC-t, 6.0%; P > .99) were not significantly different, but the OTSC-t group revealed a clearly higher rate of recurrent bleeding (34.9% vs 7.6%, P < .001) and necessity of red blood cell transfusions (5.1 ± 3.4 vs 2.5 ± 2.4 concentrates, P < .001).

Conclusions: For OTSC use, the OTSC-a should be the preferred option for duodenal ulcer bleeding.

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Source
http://dx.doi.org/10.1016/j.gie.2023.01.051DOI Listing

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