CC BY-NC-ND 4.0 · Endosc Int Open 2019; 07(06): E846-E854
DOI: 10.1055/a-0898-3357
Original article
Owner and Copyright © Georg Thieme Verlag KG 2019

Over-the-scope clip in peptic ulcer bleeding: clinical success in primary and secondary treatment and factors associated with treatment failure

Stefan Gölder
1  University Hospital Augsburg, Department of Internal Medicine III, Augsburg, Germany
,
Lukas Neuhas
2  Klinikum Dritter Orden, Department of Internal Medicine I, Munich, Germany
,
Denis Freuer
3  Chair of Epidemiology of the LMU Munich at UNIKA-T, Augsburg, Germany
,
Andreas Probst
1  University Hospital Augsburg, Department of Internal Medicine III, Augsburg, Germany
,
Alanna Ebigbo
1  University Hospital Augsburg, Department of Internal Medicine III, Augsburg, Germany
,
Georg Braun
1  University Hospital Augsburg, Department of Internal Medicine III, Augsburg, Germany
,
Juliane Brueckner
2  Klinikum Dritter Orden, Department of Internal Medicine I, Munich, Germany
,
Johannes Stueckle
2  Klinikum Dritter Orden, Department of Internal Medicine I, Munich, Germany
,
Alexander Meier
2  Klinikum Dritter Orden, Department of Internal Medicine I, Munich, Germany
,
Helmut Messmann
1  University Hospital Augsburg, Department of Internal Medicine III, Augsburg, Germany
› Author Affiliations
Further Information

Publication History

submitted 09 November 2018

accepted after revision 25 March 2019

Publication Date:
13 June 2019 (online)

Abstract

Background and study aims It is unclear if the clinical success rate of the over-the-scope-clip (OTSC) in peptic ulcer bleeding (PUB) is comparable when it is used in the first- or in the second-line of treatment.

Patients and methods Data on endoscopic treatment (first- vs. second-line) in PUB with OTSC and clinical data were analyzed. The primary outcome was the clinical success of hemostasis, defined as the absence of recurrent bleeding or further intervention. Secondary outcomes were factors associated with OTSC failure.

Results From April 2014 to March 2018, 100 patients (age 72 [20 – 98] y, female 36 %) with PUB in the stomach or the duodenum were treated endoscopically with the OTSC. The OTSC was used as a first-line procedure (primary-OTSC) in 66 pts. Successful hemostasis could be achieved in 90.9 %. After failure of an initial endoscopic treatment, 34 patients were treated with the OTSC (secondary-OTSC) and the treatment was successful in 94.1 %. Recurrent bleeding occurred in n = 10 for primary-OTSC (16.7 %) and in n = 7 pts in the secondary-OTSC (21.9 %) (P = 0.81). Clinical success in the primary-OTSC was 75.8 % and 73.5 % in the secondary-OTSC respectively.

Conclusions The OTSC has a high rate of initial bleeding control in first- and second line treatment of PUB. OTSC failure occurs more often in the duodenum than in the stomach and results in longer intensive care unit stay, higher amount of transfusions, and a higher reimbursement per case.