CC BY-NC-ND 4.0 · Endosc Int Open 2018; 06(11): E1317-E1321
DOI: 10.1055/a-0746-8435
Original article
Owner and Copyright © Georg Thieme Verlag KG 2018

First-line endoscopic treatment with over-the-scope clips in patients with either upper or lower gastrointestinal bleeding: a multicenter study

Raffaele Manta
 1  Digestive Endoscopy Unit, S.Agostino-Estense Hospital, Modena, Italy
,
Santi Mangiafico
 1  Digestive Endoscopy Unit, S.Agostino-Estense Hospital, Modena, Italy
,
Angelo Zullo
 2  Gastroenterology Unit, Nuovo Regina Margherita Hospital, Rome, Italy
,
Helga Bertani
 1  Digestive Endoscopy Unit, S.Agostino-Estense Hospital, Modena, Italy
,
Angelo Caruso
 1  Digestive Endoscopy Unit, S.Agostino-Estense Hospital, Modena, Italy
,
Giuseppe Grande
 1  Digestive Endoscopy Unit, S.Agostino-Estense Hospital, Modena, Italy
,
Francesco Paolo Zito
 1  Digestive Endoscopy Unit, S.Agostino-Estense Hospital, Modena, Italy
,
Benedetto Mangiavillano
 3  Digestive Endoscopy Unit, Humanitas – Mater Domini Hospital, Castellanza, Varese, Italy
,
Luigi Pasquale
 4  Gastroenterology Unit, San Giuseppe Moscati Hospital, Avellino, Italy
,
Andrea Parodi
 5  Gastroenterology Unit, Galliera Hospital, Genova, Italy
,
Bastianello Germanà
 6  Gastroenterology and Digestive Endoscopy Unit, Belluno Hospital, Belluno, Italy
,
Gabrio Bassotti
 7  Gastroenterology Unit, Department of Medicine, Perugia University, Perugia, Italy
,
Fabio Monica
 8  Gastroenterology Unit, Azienda Sanitaria Universitaria Integrata, Trieste, Italy
,
Maurizio Zilli
 9  Gastroenterology Unit, Azienda Sanitaria Universitaria Integrata, Udine, Italy
,
Antonio Pisani
10  Gastroenterology Section, Department of Emergency and Organ Transplantation, Bari University, Bari, Italy
,
Massimiliano Mutignani
11  Digestive Endoscopy Unit, Niguarda Hospital, Milan, Italy
,
Rita Conigliaro
 1  Digestive Endoscopy Unit, S.Agostino-Estense Hospital, Modena, Italy
,
Giuseppe Galloro
12  Surgical Digestive Endoscopy, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
› Author Affiliations
Further Information

Publication History

submitted 12 June 2018

accepted after revision 06 August 2018

Publication Date:
07 November 2018 (online)

  

Abstract

Background and study aims Endoscopic treatment is the mainstay approach for gastrointestinal bleeding, in either upper (UGIB) or lower (LGIB) tract. The over-the-scope clip (OTSC) may overcome limitations of standard clips or thermocoagulation in high-risk bleeding lesions. We evaluate the main clinically relevant outcomes following endoscopic hemostasis with OTSC in high-risk lesions and/or patients.

Patients and methods This was a retrospective analysis of prospectively collected databases including all patients with UGIB and LGIB who underwent OTCS placement as first-line treatment in eleven tertiary endoscopic referral centers. Technical success, primary hemostasis, rebleeding, blood transfusion, hospital stay, and hemorrhage-related mortality rates were evaluated.

Results Data from 286 patients, with either UGIB (N = 214) or LGIB (N = 72) were available. Overall, 112 patients (39.2 %) were receiving antithrombotic therapy. Technical success and primary hemostasis rates were 97.9 % and 96.4 %, respectively. Early rebleeding occurred in 4.4 %, more frequently in those on antithrombotic therapy, and no late rebleeding was observed. Following a successful primary haemostasis, only 5.2 % patients needed blood transfusions, and the median hospital stay was 4 days (range: 3 – 11). Eighteen patients with either technical failure (N = 6) or rebleeding (N = 12) underwent radiological or surgical approaches. Overall, bleeding-related deaths occurred in 5 (1.7 %) patients, including 3 patients with technical procedural failure, and 2 in the rebleeding group. 

Conclusions Data from our large, multicenter study show that OTSC placement is an effective first-line treatment for hemostasis in high-risk patients and/or lesions both in upper and lower gastrointestinal tract.