Over-The-Scope Clip system as a first-line therapy for high-risk bleeding peptic ulcers: a retrospective study
Background Effective hemostasis is essential to prevent rebleeding. We evaluated the efficacy and feasibility of the Over-The-Scope Clip (OTSC) system compared to combined therapy (through-the-scope clips with epinephrine injection) as a first-line endoscopic treatment for high-risk bleeding peptic...
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| Veröffentlicht in: | Surgical endoscopy 2021-05, Vol.35 (5), p.2198-2205 |
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| creator | Robles-Medranda, Carlos Oleas, Roberto Alcívar-Vásquez, Juan Puga-Tejada, Miguel Baquerizo-Burgos, Jorge Pitanga-Lukashok, Hannah |
| description | Background
Effective hemostasis is essential to prevent rebleeding. We evaluated the efficacy and feasibility of the Over-The-Scope Clip (OTSC) system compared to combined therapy (through-the-scope clips with epinephrine injection) as a first-line endoscopic treatment for high-risk bleeding peptic ulcers.
Methods
We retrospectively analyzed data of 95 patients from a single, tertiary center and underwent either OTSC (
n
= 46) or combined therapy (
n
= 49). The primary outcome of the present study was the efficacy of the OTSC system as a first-line therapy in patients with high-risk bleeding peptic ulcers compared to combined therapy with TTS clips and epinephrine injection. The secondary outcomes included the rebleeding rate, perforation rate, mean procedure time, reintervention rate, mean procedure cost and days of hospitalization in the two study groups within 30 days of the index procedure.
Results
All patients achieved hemostasis within the procedure; two patients in the OTSC group and four patients in the combined therapy group developed rebleeding (
p
= 0.444). No patients experienced gastrointestinal perforation. OTSC had a shorter median procedure time than combined therapy (11 min versus 20 min;
p
|
| doi_str_mv | 10.1007/s00464-020-07625-1 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2401808543</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2515482286</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-ae62f8f0ff43a56da154e1b3d9e606285dbb89c231c83395bd926aad702890cf3</originalsourceid><addsrcrecordid>eNp9kTtvFDEUhS0EIkvCH6BAlmhoDH6PTYdWvKRIKUhqy-O53nWYnRlsT6T99zFsAIki1S3ud859HIReMfqOUdq9L5RKLQnllNBOc0XYE7RhUnDCOTNP0YZaQQnvrDxDL0q5pY23TD1HZ4ILK5nuNmi6uoNMrvdAvod5Abwd04LLsVQ4YF-wxzHlUsmYJsB1D9kvRxznjPdptyc5lR-4HwGGNO3wAktNAa9jgFw-NGmGmueyQKjpDnCp63C8QM-iHwu8fKjn6Obzp-vtV3J59eXb9uMlCaJTlXjQPJpIY5TCKz14piSwXgwWNNXcqKHvjQ1csGCEsKofLNfeDx3lxtIQxTl6e_Jd8vxzhVLdIZUA4-gnmNfiuKTMUKOkaOib_9Dbec1T285x1eYazo1uFD9RoZ1UMkS35HTw-egYdb_ScKc0XEvD_U7DsSZ6_WC99gcY_kr-vL8B4gSU1pp2kP_NfsT2Hmz8lQw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2515482286</pqid></control><display><type>article</type><title>Over-The-Scope Clip system as a first-line therapy for high-risk bleeding peptic ulcers: a retrospective study</title><source>SpringerLink Journals - AutoHoldings</source><creator>Robles-Medranda, Carlos ; Oleas, Roberto ; Alcívar-Vásquez, Juan ; Puga-Tejada, Miguel ; Baquerizo-Burgos, Jorge ; Pitanga-Lukashok, Hannah</creator><creatorcontrib>Robles-Medranda, Carlos ; Oleas, Roberto ; Alcívar-Vásquez, Juan ; Puga-Tejada, Miguel ; Baquerizo-Burgos, Jorge ; Pitanga-Lukashok, Hannah</creatorcontrib><description>Background
Effective hemostasis is essential to prevent rebleeding. We evaluated the efficacy and feasibility of the Over-The-Scope Clip (OTSC) system compared to combined therapy (through-the-scope clips with epinephrine injection) as a first-line endoscopic treatment for high-risk bleeding peptic ulcers.
Methods
We retrospectively analyzed data of 95 patients from a single, tertiary center and underwent either OTSC (
n
= 46) or combined therapy (
n
= 49). The primary outcome of the present study was the efficacy of the OTSC system as a first-line therapy in patients with high-risk bleeding peptic ulcers compared to combined therapy with TTS clips and epinephrine injection. The secondary outcomes included the rebleeding rate, perforation rate, mean procedure time, reintervention rate, mean procedure cost and days of hospitalization in the two study groups within 30 days of the index procedure.
Results
All patients achieved hemostasis within the procedure; two patients in the OTSC group and four patients in the combined therapy group developed rebleeding (
p
= 0.444). No patients experienced gastrointestinal perforation. OTSC had a shorter median procedure time than combined therapy (11 min versus 20 min;
p
< 0.001). The procedure cost was superior for OTSC compared to combined therapy ($102,000 versus $101,000;
p
< 0.001). We found no significant difference in the rebleeding prevention rate (95.6% versus 91.8%,
p
= 0.678), hospitalization days (3 days versus 4 days;
p
= 0.215), and hospitalization costs ($108,000 versus $240,000,
p
= 0.215) of the OTSC group compared to the combined therapy group.
Conclusion
OTSC treatment is an effective and feasible first-line therapy for high-risk bleeding peptic ulcers. OTSC confers comparable costs and patient outcomes as combined treatments, with a shorter procedure time.</description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-020-07625-1</identifier><identifier>PMID: 32394167</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Abdominal Surgery ; Endoscopy ; Gastroenterology ; Gynecology ; Hepatology ; Hospitalization ; Medicine ; Medicine & Public Health ; Mortality ; Patients ; Prevention ; Proctology ; Surgery ; Ulcers</subject><ispartof>Surgical endoscopy, 2021-05, Vol.35 (5), p.2198-2205</ispartof><rights>Springer Science+Business Media, LLC, part of Springer Nature 2020</rights><rights>Springer Science+Business Media, LLC, part of Springer Nature 2020.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-ae62f8f0ff43a56da154e1b3d9e606285dbb89c231c83395bd926aad702890cf3</citedby><cites>FETCH-LOGICAL-c375t-ae62f8f0ff43a56da154e1b3d9e606285dbb89c231c83395bd926aad702890cf3</cites><orcidid>0000-0003-2434-3369</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-020-07625-1$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-020-07625-1$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27922,27923,41486,42555,51317</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32394167$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Robles-Medranda, Carlos</creatorcontrib><creatorcontrib>Oleas, Roberto</creatorcontrib><creatorcontrib>Alcívar-Vásquez, Juan</creatorcontrib><creatorcontrib>Puga-Tejada, Miguel</creatorcontrib><creatorcontrib>Baquerizo-Burgos, Jorge</creatorcontrib><creatorcontrib>Pitanga-Lukashok, Hannah</creatorcontrib><title>Over-The-Scope Clip system as a first-line therapy for high-risk bleeding peptic ulcers: a retrospective study</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><addtitle>Surg Endosc</addtitle><description>Background
Effective hemostasis is essential to prevent rebleeding. We evaluated the efficacy and feasibility of the Over-The-Scope Clip (OTSC) system compared to combined therapy (through-the-scope clips with epinephrine injection) as a first-line endoscopic treatment for high-risk bleeding peptic ulcers.
Methods
We retrospectively analyzed data of 95 patients from a single, tertiary center and underwent either OTSC (
n
= 46) or combined therapy (
n
= 49). The primary outcome of the present study was the efficacy of the OTSC system as a first-line therapy in patients with high-risk bleeding peptic ulcers compared to combined therapy with TTS clips and epinephrine injection. The secondary outcomes included the rebleeding rate, perforation rate, mean procedure time, reintervention rate, mean procedure cost and days of hospitalization in the two study groups within 30 days of the index procedure.
Results
All patients achieved hemostasis within the procedure; two patients in the OTSC group and four patients in the combined therapy group developed rebleeding (
p
= 0.444). No patients experienced gastrointestinal perforation. OTSC had a shorter median procedure time than combined therapy (11 min versus 20 min;
p
< 0.001). The procedure cost was superior for OTSC compared to combined therapy ($102,000 versus $101,000;
p
< 0.001). We found no significant difference in the rebleeding prevention rate (95.6% versus 91.8%,
p
= 0.678), hospitalization days (3 days versus 4 days;
p
= 0.215), and hospitalization costs ($108,000 versus $240,000,
p
= 0.215) of the OTSC group compared to the combined therapy group.
Conclusion
OTSC treatment is an effective and feasible first-line therapy for high-risk bleeding peptic ulcers. OTSC confers comparable costs and patient outcomes as combined treatments, with a shorter procedure time.</description><subject>Abdominal Surgery</subject><subject>Endoscopy</subject><subject>Gastroenterology</subject><subject>Gynecology</subject><subject>Hepatology</subject><subject>Hospitalization</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Mortality</subject><subject>Patients</subject><subject>Prevention</subject><subject>Proctology</subject><subject>Surgery</subject><subject>Ulcers</subject><issn>0930-2794</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kTtvFDEUhS0EIkvCH6BAlmhoDH6PTYdWvKRIKUhqy-O53nWYnRlsT6T99zFsAIki1S3ud859HIReMfqOUdq9L5RKLQnllNBOc0XYE7RhUnDCOTNP0YZaQQnvrDxDL0q5pY23TD1HZ4ILK5nuNmi6uoNMrvdAvod5Abwd04LLsVQ4YF-wxzHlUsmYJsB1D9kvRxznjPdptyc5lR-4HwGGNO3wAktNAa9jgFw-NGmGmueyQKjpDnCp63C8QM-iHwu8fKjn6Obzp-vtV3J59eXb9uMlCaJTlXjQPJpIY5TCKz14piSwXgwWNNXcqKHvjQ1csGCEsKofLNfeDx3lxtIQxTl6e_Jd8vxzhVLdIZUA4-gnmNfiuKTMUKOkaOib_9Dbec1T285x1eYazo1uFD9RoZ1UMkS35HTw-egYdb_ScKc0XEvD_U7DsSZ6_WC99gcY_kr-vL8B4gSU1pp2kP_NfsT2Hmz8lQw</recordid><startdate>20210501</startdate><enddate>20210501</enddate><creator>Robles-Medranda, Carlos</creator><creator>Oleas, Roberto</creator><creator>Alcívar-Vásquez, Juan</creator><creator>Puga-Tejada, Miguel</creator><creator>Baquerizo-Burgos, Jorge</creator><creator>Pitanga-Lukashok, Hannah</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-2434-3369</orcidid></search><sort><creationdate>20210501</creationdate><title>Over-The-Scope Clip system as a first-line therapy for high-risk bleeding peptic ulcers: a retrospective study</title><author>Robles-Medranda, Carlos ; Oleas, Roberto ; Alcívar-Vásquez, Juan ; Puga-Tejada, Miguel ; Baquerizo-Burgos, Jorge ; Pitanga-Lukashok, Hannah</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-ae62f8f0ff43a56da154e1b3d9e606285dbb89c231c83395bd926aad702890cf3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Abdominal Surgery</topic><topic>Endoscopy</topic><topic>Gastroenterology</topic><topic>Gynecology</topic><topic>Hepatology</topic><topic>Hospitalization</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Mortality</topic><topic>Patients</topic><topic>Prevention</topic><topic>Proctology</topic><topic>Surgery</topic><topic>Ulcers</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Robles-Medranda, Carlos</creatorcontrib><creatorcontrib>Oleas, Roberto</creatorcontrib><creatorcontrib>Alcívar-Vásquez, Juan</creatorcontrib><creatorcontrib>Puga-Tejada, Miguel</creatorcontrib><creatorcontrib>Baquerizo-Burgos, Jorge</creatorcontrib><creatorcontrib>Pitanga-Lukashok, Hannah</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Robles-Medranda, Carlos</au><au>Oleas, Roberto</au><au>Alcívar-Vásquez, Juan</au><au>Puga-Tejada, Miguel</au><au>Baquerizo-Burgos, Jorge</au><au>Pitanga-Lukashok, Hannah</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Over-The-Scope Clip system as a first-line therapy for high-risk bleeding peptic ulcers: a retrospective study</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><addtitle>Surg Endosc</addtitle><date>2021-05-01</date><risdate>2021</risdate><volume>35</volume><issue>5</issue><spage>2198</spage><epage>2205</epage><pages>2198-2205</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><abstract>Background
Effective hemostasis is essential to prevent rebleeding. We evaluated the efficacy and feasibility of the Over-The-Scope Clip (OTSC) system compared to combined therapy (through-the-scope clips with epinephrine injection) as a first-line endoscopic treatment for high-risk bleeding peptic ulcers.
Methods
We retrospectively analyzed data of 95 patients from a single, tertiary center and underwent either OTSC (
n
= 46) or combined therapy (
n
= 49). The primary outcome of the present study was the efficacy of the OTSC system as a first-line therapy in patients with high-risk bleeding peptic ulcers compared to combined therapy with TTS clips and epinephrine injection. The secondary outcomes included the rebleeding rate, perforation rate, mean procedure time, reintervention rate, mean procedure cost and days of hospitalization in the two study groups within 30 days of the index procedure.
Results
All patients achieved hemostasis within the procedure; two patients in the OTSC group and four patients in the combined therapy group developed rebleeding (
p
= 0.444). No patients experienced gastrointestinal perforation. OTSC had a shorter median procedure time than combined therapy (11 min versus 20 min;
p
< 0.001). The procedure cost was superior for OTSC compared to combined therapy ($102,000 versus $101,000;
p
< 0.001). We found no significant difference in the rebleeding prevention rate (95.6% versus 91.8%,
p
= 0.678), hospitalization days (3 days versus 4 days;
p
= 0.215), and hospitalization costs ($108,000 versus $240,000,
p
= 0.215) of the OTSC group compared to the combined therapy group.
Conclusion
OTSC treatment is an effective and feasible first-line therapy for high-risk bleeding peptic ulcers. OTSC confers comparable costs and patient outcomes as combined treatments, with a shorter procedure time.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>32394167</pmid><doi>10.1007/s00464-020-07625-1</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0003-2434-3369</orcidid></addata></record> |
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| identifier | ISSN: 0930-2794 |
| ispartof | Surgical endoscopy, 2021-05, Vol.35 (5), p.2198-2205 |
| issn | 0930-2794 1432-2218 |
| language | eng |
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| source | SpringerLink Journals - AutoHoldings |
| subjects | Abdominal Surgery Endoscopy Gastroenterology Gynecology Hepatology Hospitalization Medicine Medicine & Public Health Mortality Patients Prevention Proctology Surgery Ulcers |
| title | Over-The-Scope Clip system as a first-line therapy for high-risk bleeding peptic ulcers: a retrospective study |
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