American College of Gastroenterology Annual Meeting

American College of Gastroenterology Annual Meeting

Perspective from Sunguk Jang, MD
October 28, 2019
3 min read
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Over-the-scope clips reduce upper GI rebleeding

Perspective from Sunguk Jang, MD
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SAN ANTONIO — Patients with upper gastrointestinal bleeding treated with large, over-the-scope hemoclips experienced lower rates of rebleeding and severe complications, according to data presented at the American College of Gastroenterology Annual Meeting.

According to Dennis M. Jensen, MD, FACG, of the David Geffen School of Medicine at University of California, Los Angeles, recurrent bleeding from peptic ulcers and Dieulafoy’s lesions is common, and high-risk patients who receive standard treatment have a rebleeding rate of more than 26%.

“With visually guided, over-the-scope large clips, you can obliterate the blood flow underneath the stigmata, and most of the time, those patients don’t rebleed,” Jensen said in his presentation.

Researchers conducted a randomized controlled trial to compared over-the-scope clips (OTSC) with standard treatment (hemoclips and/or multipolar probe with epinephrine pre-injection). They randomly assigned patients who met clinical and emergency endoscopy criteria for peptic ulcers or Dieulafoy’ lesions (n = 49) to undergo standard treatment or OTSC. All patients received high dose proton pump inhibitors after randomization and were followed prospectively for 30 days.

Clinically significant rebleeding within 30 days served as the primary endpoint.

The proportion of patients with 30-day rebleeding in the OTSC group was 4.2% (1/24) compared with 28% (7/25) in the standard group (P = .022). The rebleed rate in the OTSC group was 85% lower than the standard group (RR = 0.149; 95% CI, 0.006-0.863).

The standard group also had higher rates of severe complications compared with the OTSC group (16% vs. 0%; P = .041).

Jensen said their findings appear to show the superiority of OTSC over standard treatment to reduce lesion rebleeding.

“These results primarily relate to the larger clip’s ability to obliterate underlying arterial blood flow, which is a significant risk factor for rebleeding,” he said. “It seems like only the patients with significant stigmata of hemorrhage benefited from this large clip, and it is unlikely that the lesser stigmata will because the standard treatment also worked very well.” – by Alex Young

Reference:

Jensen DM, et al. Abstract 8. Presented at: American College of Gastroenterology Annual Meeting; Oct. 25-30, 2019; San Antonio.

Disclosures: The authors report no relevant financial disclosures.