Division of Gastroenterology, Medical Department II, University of Leipzig Medical Center, Leipzig, Germany.
Department of Medicine II, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Gastrointest Endosc. 2023 Jul;98(1):51-58.e2. doi: 10.1016/j.gie.2023.01.051. Epub 2023 Feb 3.
Over-the-scope clips (OTSCs) substantially improved the endoscopic armamentarium for the treatment of severe GI bleeding and can potentially overcome limitations of standard clips. Data indicate a superiority of OTSCs in hemostasis as first- and second-line therapy. However, the impact of the OTSC designs, in particular the traumatic (-t) or atraumatic (-a) type, in duodenal ulcer bleeding has not been analyzed so far.
This was a retrospective analysis of a prospective collected database from 2009 to 2020 of 6 German endoscopic centers. All patients who underwent emergency endoscopy and were treated using an OTSC for duodenal ulcer bleeding were included. OTSC-t and OTSC-a patients were compared by the Fisher exact test, χ test, or Mann-Whitney U test as appropriate. A propensity score-based 1:1 matching was performed to obtain equal distribution of baseline characteristics in both groups.
The entire cohort comprised 173 patients (93 OTSC-a, 80 OTSC-t). Age, gender, anticoagulant therapy, Rockall score, and treatment regimen had similar distributions in the 2 groups. However, the OTSC-t group showed significantly more active bleeding ulcers (Forrest Ia/b). Matching identified 132 patients (66 in both groups) with comparable baseline characteristics. Initial bleeding hemostasis (OTSC-a, 90.9%; OTSC-t, 87.9%; P = .82) and 72-hour mortality (OTSC-a, 4.5%; OTSC-t, 6.0%; P > .99) were not significantly different, but the OTSC-t group revealed a clearly higher rate of recurrent bleeding (34.9% vs 7.6%, P < .001) and necessity of red blood cell transfusions (5.1 ± 3.4 vs 2.5 ± 2.4 concentrates, P < .001).
For OTSC use, the OTSC-a should be the preferred option for duodenal ulcer bleeding.
过内镜用结扎夹（OTSCs）显著改善了严重胃肠道出血的内镜治疗手段，并且可能克服标准夹的局限性。数据表明，OTSCs 在作为一线和二线治疗时在止血方面具有优势。然而，OTSC 设计（特别是创伤型[-t]或非创伤型[-a]）对十二指肠溃疡出血的影响尚未进行分析。
这是对 2009 年至 2020 年来自德国 6 个内镜中心的前瞻性采集数据库进行的回顾性分析。所有接受紧急内镜检查并使用 OTSC 治疗十二指肠溃疡出血的患者均被纳入研究。OTSC-t 和 OTSC-a 患者的比较采用 Fisher 确切检验、χ检验或 Mann-Whitney U 检验。采用倾向评分 1:1 匹配法，使两组患者的基线特征均衡分布。
整个队列包括 173 例患者（93 例 OTSC-a，80 例 OTSC-t）。两组患者的年龄、性别、抗凝治疗、Rockall 评分和治疗方案分布相似。然而，OTSC-t 组显示出更明显的活动性出血性溃疡（Forrest Ia/b）。匹配后共纳入 132 例患者（每组 66 例），两组患者的基线特征具有可比性。初次出血止血（OTSC-a：90.9%；OTSC-t：87.9%；P=.82）和 72 小时死亡率（OTSC-a：4.5%；OTSC-t：6.0%；P>.99）无显著差异，但 OTSC-t 组的再出血率（34.9% vs 7.6%，P<.001）和红细胞输血需求（5.1±3.4 vs 2.5±2.4 浓缩物，P<.001）明显更高。
对于 OTSC 的使用，对于十二指肠溃疡出血，OTSC-a 应作为首选。
