Over-the-scope clip vs epinephrine with clip for first-line hemostasis in non-variceal upper gastrointestinal bleeding: a propensity score match analysis
Background and study aims The over-the-scope clip (OTSC) is a novel tool used to improve the maintenance of hemostasis for non-variceal upper gastrointestinal bleeding (NVUGIB); however, studies on the comparison with “conventional” techniques are lacking. In this study, we aimed to compare first-li...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Georg Thieme Verlag KG
2020-01-01
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| Series: | Endoscopy International Open |
| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/a-1005-6401 |
| _version_ | 1818339963727511552 |
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| author | Santi Mangiafico Flavia Pigò Helga Bertani Angelo Caruso Giuseppe Grande Costantino Sgamato Raffaele Manta Rita Conigliaro |
| author_facet | Santi Mangiafico Flavia Pigò Helga Bertani Angelo Caruso Giuseppe Grande Costantino Sgamato Raffaele Manta Rita Conigliaro |
| author_sort | Santi Mangiafico |
| collection | DOAJ |
| description | Background and study aims The over-the-scope clip (OTSC) is a novel tool used to improve the maintenance of hemostasis for non-variceal upper gastrointestinal bleeding (NVUGIB); however, studies on the comparison with “conventional” techniques are lacking. In this study, we aimed to compare first-line endoscopic hemostasis achieved using conventional techniques with that achieved using OTSC placement for NVUGIB.
Patients and methods From January 2007 to March 2018, 793 consecutive patients underwent upper endoscopy with the hemostasis procedure. Among them, 327 patients were eligible for inclusion (112 patients had OTSC placement and 215 underwent conventional hemostasis). After propensity score matching and adjustment for confounding factors, 84 patients were stratified into the “conventional” group and 84 into the OTSC group. Patient characteristics and outcomes (rebleeding rate, mortality rate within 30 days, and adverse events) were compared between the two groups.
Results In the unmatched cohort, hemostasis with OTSC was more frequent in cases of duodenal ulcers with Forrest Ia to IIa and in patients with a higher Rockall score compared with the “conventional group”. In the matched cohort, 93 % of the patients in the “conventional group” underwent hemostasis with epinephrine + through-the-scope clip. Rebleeding events were significantly less frequent in the OTSC group (8 % vs 20 %, 95 %CI 3 – 16 vs 12 – 30; P = 0.02); however, the mortality rate in the two groups was not significantly different (6 % vs 2 %, 95 %CI 1 – 8 vs 2 – 13; P = 0.4).
Conclusions OTSC is a safe and effective tool for achieving hemostasis, and we recommend its use as the first-line therapy for lesions with a high risk of rebleeding and in patients with a high risk Rockall score. |
| first_indexed | 2024-12-13T15:35:21Z |
| format | Article |
| id | doaj.art-d90869b20cd54a5c831fcd17444cca2d |
| institution | Directory Open Access Journal |
| issn | 2364-3722 2196-9736 |
| language | English |
| last_indexed | 2024-12-13T15:35:21Z |
| publishDate | 2020-01-01 |
| publisher | Georg Thieme Verlag KG |
| record_format | Article |
| series | Endoscopy International Open |
| spelling | doaj.art-d90869b20cd54a5c831fcd17444cca2d2022-12-21T23:40:03ZengGeorg Thieme Verlag KGEndoscopy International Open2364-37222196-97362020-01-010801E50E5810.1055/a-1005-6401Over-the-scope clip vs epinephrine with clip for first-line hemostasis in non-variceal upper gastrointestinal bleeding: a propensity score match analysisSanti Mangiafico0Flavia Pigò1Helga Bertani2Angelo Caruso3Giuseppe Grande4Costantino Sgamato5Raffaele Manta6Rita Conigliaro7Azienda Ospedaliero-Universitaria di Modena Ospedale Civile di Baggiovara, Gastroenterology and Digestive Endoscopy Unit, Modena, ItalyAzienda Ospedaliero-Universitaria di Modena Ospedale Civile di Baggiovara, Gastroenterology and Digestive Endoscopy Unit, Modena, ItalyAzienda Ospedaliero-Universitaria di Modena Ospedale Civile di Baggiovara, Gastroenterology and Digestive Endoscopy Unit, Modena, ItalyAzienda Ospedaliero-Universitaria di Modena Ospedale Civile di Baggiovara, Gastroenterology and Digestive Endoscopy Unit, Modena, ItalyAzienda Ospedaliero-Universitaria di Modena Ospedale Civile di Baggiovara, Gastroenterology and Digestive Endoscopy Unit, Modena, ItalyUniversity of Naples Federico II, Department of Clinical Medicine and Surgery, Gastroenterology Unit, Naples, ItalyAzienda Ospedaliera di Perugia, Gastroenterology and Digestive Endoscopy Unit, Perugia, ItalyAzienda Ospedaliero-Universitaria di Modena Ospedale Civile di Baggiovara, Gastroenterology and Digestive Endoscopy Unit, Modena, ItalyBackground and study aims The over-the-scope clip (OTSC) is a novel tool used to improve the maintenance of hemostasis for non-variceal upper gastrointestinal bleeding (NVUGIB); however, studies on the comparison with “conventional” techniques are lacking. In this study, we aimed to compare first-line endoscopic hemostasis achieved using conventional techniques with that achieved using OTSC placement for NVUGIB. Patients and methods From January 2007 to March 2018, 793 consecutive patients underwent upper endoscopy with the hemostasis procedure. Among them, 327 patients were eligible for inclusion (112 patients had OTSC placement and 215 underwent conventional hemostasis). After propensity score matching and adjustment for confounding factors, 84 patients were stratified into the “conventional” group and 84 into the OTSC group. Patient characteristics and outcomes (rebleeding rate, mortality rate within 30 days, and adverse events) were compared between the two groups. Results In the unmatched cohort, hemostasis with OTSC was more frequent in cases of duodenal ulcers with Forrest Ia to IIa and in patients with a higher Rockall score compared with the “conventional group”. In the matched cohort, 93 % of the patients in the “conventional group” underwent hemostasis with epinephrine + through-the-scope clip. Rebleeding events were significantly less frequent in the OTSC group (8 % vs 20 %, 95 %CI 3 – 16 vs 12 – 30; P = 0.02); however, the mortality rate in the two groups was not significantly different (6 % vs 2 %, 95 %CI 1 – 8 vs 2 – 13; P = 0.4). Conclusions OTSC is a safe and effective tool for achieving hemostasis, and we recommend its use as the first-line therapy for lesions with a high risk of rebleeding and in patients with a high risk Rockall score.http://www.thieme-connect.de/DOI/DOI?10.1055/a-1005-6401 |
| spellingShingle | Santi Mangiafico Flavia Pigò Helga Bertani Angelo Caruso Giuseppe Grande Costantino Sgamato Raffaele Manta Rita Conigliaro Over-the-scope clip vs epinephrine with clip for first-line hemostasis in non-variceal upper gastrointestinal bleeding: a propensity score match analysis Endoscopy International Open |
| title | Over-the-scope clip vs epinephrine with clip for first-line hemostasis in non-variceal upper gastrointestinal bleeding: a propensity score match analysis |
| title_full | Over-the-scope clip vs epinephrine with clip for first-line hemostasis in non-variceal upper gastrointestinal bleeding: a propensity score match analysis |
| title_fullStr | Over-the-scope clip vs epinephrine with clip for first-line hemostasis in non-variceal upper gastrointestinal bleeding: a propensity score match analysis |
| title_full_unstemmed | Over-the-scope clip vs epinephrine with clip for first-line hemostasis in non-variceal upper gastrointestinal bleeding: a propensity score match analysis |
| title_short | Over-the-scope clip vs epinephrine with clip for first-line hemostasis in non-variceal upper gastrointestinal bleeding: a propensity score match analysis |
| title_sort | over the scope clip vs epinephrine with clip for first line hemostasis in non variceal upper gastrointestinal bleeding a propensity score match analysis |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/a-1005-6401 |
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