Efficacy and safety of over-the-scope-clips in the therapy of acute nonvariceal upper gastrointestinal bleeding:Meta-analysis

BACKGROUND Acute nonvariceal upper gastrointestinal bleeding(ANVUGIB)is a frequent lifethreatening acute condition in gastroenterology associated with high morbidity and mortality.Over-the-scope-clip(OTSC)is a new endoscopic hemostasis technique,which is being used in ANVUGIB and is more effective.AIM To summarize and analyze the effects of the OTSC in prevention of recurrent bleeding,clinical success rate,procedure time,hospital stay,and adverse events in the treatment of ANVUGIB,to evaluate whether OTSC can replace standard endoscopic therapy as a new generation of treatment for ANVUGIB.METHODS The literature related to OTSC and standard therapy for ANVUGIB published before January 2023 was searched in PubMed,Web of Science,EMBASE,Cochrane,Google,and CNKI databases.Changes in recurrent bleeding(7 or 30 days),clinical results(clinical success rate,conversion rate to surgery,mortality),therapy time(procedure time,hospital stay),and adverse events in the OTSC intervention group were summarized and analyzed,and the MD or OR of 95%CI is calculated by Review Manager 5.3.RESULTS This meta-analysis involved 11 studies with 1266 patients.Total risk of bias was moderate-to-high.For patients in the OTSC group,7-and 30-days recurrent bleeding rates,as well as procedure time,hospital stay,and intensive care unit stay,were greatly inhibited.OTSC could significantly improve the clinical success rate of ANVUGIB.OTSC therapy did not cause serious adverse and was effective in reducing patient mortality.CONCLUSION OTSC may provide more rapid and sustained hemostasis,and thus,promote recovery and reduce mortality in patients with ANVUGIB.In addition,the safety of OTSC is assured.

Endoscopic treatment modalities and outcomes in nonvariceal upper gastrointestinal bleeding

BACKGROUND In nonvariceal upper gastrointestinal bleeding(NVUGIB),the optimal volume of adrenaline,the optimal number of hemoclips,and the application of thermal coagulation in determining patient outcomes have not been well studied.AIM To demonstrate a dose-response relationship between the commonly used endoscopic modalities for the treatment of non-variceal upper gastrointestinal bleeding and various clinical outcomes.METHODS Patients presenting with NVUGIB were retrospectively identified and analyzed.These patients were stratified as follows:(1)>10 mL of adrenaline injected vs≤10 mL;(2)>1 hemoclip placed vs≤1 hemoclip;(3)Heater probe used or not;and(4)>2 treatment modalities used vs≤2.The primary outcomes were rebleeding and the need for repeat endoscopy.The secondary outcomes were the need for surgery,required transfusions,length of hospital stay,death during the same admission period and 30 d mortality.Patients with NVUGIB who required endoscopic therapy were included.Those who did not require endoscopic therapy or were initially treated with surgery or embolization were excluded.RESULTS In all,501 patients with NVUGIB were treated.One hundred sixty-one(32.1%)patients needed endoscopic therapy.The injection of<10 mL of adrenaline was associated with less rebleeding(P<0.0001),the need for repeat endoscopy(P=0.001)and a decreased length of hospital stay(P=0.026).The use of>2 treatment modalities were associated with increased rebleeding(P=0.009)and the need for repeat endoscopy(P=0.048).The placement of>1 hemoclip was associated with a decreased length of hospital stay(P=0.044).The rates of surgery and death were low,and there were no other significant differences between the patient groups.CONCLUSION The more restrictive use of adrenaline and number of endoscopic modalities to treat NVUGIB with the more liberal use of hemoclips was associated with better patient outcomes.

Endoclips vs large or small-volume epinephrine in peptic ulcer recurrent bleeding

AIM:To compare the recurrent bleeding after endoscopic injection of different epinephrine volumes with hemoclips in patients with bleeding peptic ulcer.METHODS:Between January 2005 and December 2009,150 patients with gastric or duodenal bleeding ulcer with major stigmata of hemorrhage and nonbleeding visible vessel in an ulcer bed(Forrest Ⅱa) were included in the study.Patients were randomized to receive a small-volume epinephrine group(15 to 25 mL injection group;Group 1,n = 50),a large-volume epinephrine group(30 to 40 mL injection group;Group 2,n = 50) and a hemoclip group(Group 3,n = 50).The rate of recurrent bleeding,as the primary outcome,was compared between the groups of patients included in the study.Secondary outcomes compared between the groups were primary hemostasis rate,permanent hemostasis,need for emergency surgery,30 d mortality,bleeding-related deaths,length of hospital stay and transfusion requirements.RESULTS:Initial hemostasis was obtained in all patients.The rate of early recurrent bleeding was 30%(15/50) in the small-volume epinephrine group(Group 1) and 16%(8/50) in the large-volume epinephrine group(Group 2)(P = 0.09).The rate of recurrent bleeding was 4%(2/50) in the hemoclip group(Group 3);the difference was statistically significant with regard to patients treated with either small-volume or large-volume epinephrine solution(P = 0.0005 and P = 0.045,respectively).Duration of hospital stay was significantly shorter among patients treated with hemoclips than among patients treated with epinephrine whereas there were no differences in transfusion requirement or even 30 d mortality between the groups.CONCLUSION:Endoclip is superior to both small and large volume injection of epinephrine in the prevention of recurrent bleeding in patients with peptic ulcer.

Gastric ulcer treated using an elastic traction ring combined with clip: A case report

BACKGROUND There is a high annual incidence of acute,nonvariceal upper gastrointestinal bleeding in Chinese adults.Early endoscopic intervention can reduce rates of rebleeding,surgery,and mortality.The metal clip is the most common method for establishing homeostasis;however,it possesses several limitations.In patients with bleeding secondary to large gastric ulcers,the clip will often fail to stop the bleeding.This article highlights the use of an elastic traction ring as a novel hemostatic method for patients with upper gastrointestinal bleeding.CASE SUMMARY An elderly male presented to the emergency room with complaints of hematemesis and melena.Endoscopic examination revealed an ulcer(Forrest IIa)in the lesser curvature of the gastric antrum.Six tissue clips and one elastic traction ring were inserted into the stomach cavity to suture the ulcer.The patient recovered quickly without postoperative gastrointestinal bleeding.Two months later,the patient's ulcer was significantly healed.CONCLUSION To our best knowledge,this is the first report to demonstrate the safety and efficacy of elastic traction rings for upper gastrointestinal bleeding.Elastic traction rings should be considered a routine therapeutic modality for patients with upper gastrointestinal bleeds.