Over-The-Scope Clips (OTSC©) Versus Surgery for Refractory Peptic Ulcer Bleeding

Aims Surgery and Transcatheter arterial embolization are considered standard treatment of peptic ulcer bleeding (PUB) refractory to endoscopic hemostasis. Over-The-Scope clips (OTSC) have shown superiority to standard endoscopic treatment but a comparison with surgery has not been performed, yet.

Methods In this retrospective study, 103 patients with refractory peptic ulcer bleeding treated either with OTSC (n = 66) or surgery (n = 37) between 2009-2019 at four academic centers were analyzed. Primary endpoint was clinical success defined as successful hemostasis and absence of rebleeding within 7 days and in-hospital mortality. Main secondary endpoints were overall and procedure-related adverse events, length of hospital and intensive care unit stay and number of transfusions. Univariate and multivariate logistic regression was performed for analysis of risk factors for mortality.

Results Baseline characteristics were similar in both groups regarding age, comorbidities, number of prior hemostasis attempts, ulcer size >20mm, and localization. The surgical group included significantly more Forrest Ia bleedings (64.9 % vs.19.7 % p = 0.001) and had more patients in shock (78.1 % vs. 43.9 %: p = 0.002).

Clinical success was similar in both groups (OTSC: 74.2 % vs surgery: 83.8 %; p = 0.329). In-hospital mortality was significantly higher in the surgical group (35.1 % vs. 9.1 %; p = 0.002) as well as stay on the ICU (7.1 vs. 18.8 days; p < 0.001), number of blood transfusions (9.4 vs. 19.9; p < 0.001), and complications arising from re-therapy after failure of OTSC or surgical treatment (37.5 % vs. 4.5 %; p < 0.001). Univariate and multivariate logistic regression confirmed complications after re-therapy as main risk factor for in-hospital mortality.

Conclusions OTSC treatment for refractory peptic ulcer bleeding shows comparable efficacy to surgery and a significantly reduced mortality. Complications following surgical treatment are responsible for this difference as shown in univariate and multivariate logistic regression.

Citation: Kuellmer A, Mangold T, Bettinger D et al. eP17 OVER-THE-SCOPE CLIPS (OTSC©) VERSUS SURGERY FOR REFRACTORY PEPTIC ULCER BLEEDING. Endoscopy 2021; 53: S102.

Publication History

Article published online:
19 March 2021