Gölder Stefan, Neuhas Lukas, Freuer Denis, Probst Andreas, Ebigbo Alanna, Braun Georg, Brueckner Juliane, Stueckle Johannes, Meier Alexander, Messmann Helmut
University Hospital Augsburg, Department of Internal Medicine III, Augsburg, Germany.
Klinikum Dritter Orden, Department of Internal Medicine I, Munich, Germany.
Endosc Int Open. 2019 Jun;7(6):E846-E854. doi: 10.1055/a-0898-3357. Epub 2019 Jun 13.
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. 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. 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 %) ( = 0.81). Clinical success in the primary-OTSC was 75.8 % and 73.5 % in the secondary-OTSC respectively. 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.
目前尚不清楚用于消化性溃疡出血（PUB）治疗的套扎式内镜夹（OTSC）在一线治疗或二线治疗中的临床成功率是否具有可比性。我们分析了使用OTSC治疗PUB的内镜治疗数据（一线治疗与二线治疗）及临床数据。主要结局是止血的临床成功率，定义为无再出血或无需进一步干预。次要结局是与OTSC失败相关的因素。2014年4月至2018年3月，100例胃或十二指肠PUB患者（年龄72[20 - 98]岁，女性36%）接受了OTSC内镜治疗。66例患者将OTSC用作一线治疗方法（一线OTSC），其中90.9%实现了成功止血。在初始内镜治疗失败后，34例患者接受了OTSC治疗（二线OTSC），治疗成功率为94.1%。一线OTSC中有10例（16.7%）发生再出血，二线OTSC中有7例（21.9%）发生再出血（P = 0.81）。一线OTSC的临床成功率分别为75.8%，二线OTSC为73.5%。OTSC在PUB的一线和二线治疗中初始出血控制率较高。OTSC失败在十二指肠比在胃中更常见，并且导致重症监护病房住院时间更长、输血量更大以及每例报销费用更高。
