Comparison of Over-the-Scope Clips to Standard Endoscopic Treatment as the Initial Treatment in Patients With Bleeding From a Nonvariceal Upper Gastrointestinal Cause

Lau, James Y.; Li, Rui; Tan, Chenhuan; Sun, Xiujing; Song, Hao-Jun; Li, Lan; Feng, Jia‐Xun; Wang, Bu-Jiang; Shi, Dongtao; Leung, Wai K.; Hartley, Imogen; Moss, Alan; Yu, Karina Y Y; Suen, Bing Yee; Chan, Francis K.L.

doi:10.7326/m22-1783

Cited by 18 publications

(25 citation statements)

References 15 publications

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“…2 shows the traffic-light plot to assess the risk of bias. The risk of bias was low in three 10 13 14 and medium in two studies. 11 12…”

Section: Resultsmentioning

confidence: 86%

“…None of the individual studies reported any difference in the risk of rebleeding at 7 days, and two reported a lower risk of rebleeding at 30 days. 11,14 The pooled analysis of the data demonstrated a significantly lower risk of both early (day 7) and late (day 30) rebleeding as compared with standard therapy with RR of 0.30 (0.16-0.59), and RR of 0.42 (0.24-0.72), respectively. This may be because the individual studies were underpowered to show a statistically significant difference.…”

Section: Discussionmentioning

confidence: 98%

“…Only one study used OTSC for secondary hemostasis after the failure of primary therapy, 10 while four studies used OTSC for primary hemostasis. [10][11][12][13][14] Two studies recruited patients exclusively with peptic ulcers, 10,13 while three recruited patients with all causes of NVUGIB. 11,12,14 Males constituted the predominant population in all studies.…”

Section: Study Characteristics and Assessment Of The Risk Of Biasmentioning

confidence: 99%

“…[10][11][12][13][14] Two studies recruited patients exclusively with peptic ulcers, 10,13 while three recruited patients with all causes of NVUGIB. 11,12,14 Males constituted the predominant population in all studies. The proportion of patients using antithrombotics varied from 6 to 84%.…”

Section: Study Characteristics and Assessment Of The Risk Of Biasmentioning

confidence: 99%

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Efficacy of Over-the-Scope Clips Compared to Standard Therapy for Nonvariceal Upper Gastrointestinal Bleeding—A Systematic Review and Meta-analysis of Randomized Trials

Giri,

Harindranath,

Kozyk

et al. 2023

Journal of Digestive Endoscopy

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Background The current standard of treatment for nonvariceal upper gastrointestinal bleeding (NVUGIB) includes endoscopic hemostasis with either through-the-scope clips or thermal therapy. However, they may be associated with rebleeding, especially in high-risk ulcers. Over-the-scope clips (OTSC) have been demonstrated in multiple recent studies to be an effective measure for NVUGIB. We aimed to analyze the current literature on standard therapy with OTSC to manage NVUGIB. Methods A meta-analysis was performed by pooling the data from randomized studies obtained from a comprehensive search of Medline, Embase, and Scopus from inception to February 2023. The outcomes analyzed included rates of persistent bleeding, rebleeding, mortality, and duration of hospitalization. Results A total of five studies were included in the final analysis. There was no significant difference in the risk of persistent bleeding between the groups, with a risk ratio (RR) of 0.29 (95% confidence interval [CI]: 0.07–1.27). The use of OTSC was associated with a significantly lower risk of 7-day and 30-day rebleeding compared with standard therapy with RR of 0.30 (95% CI: 0.16–0.59) and 0.42 (95% CI: 0.24–0.72), respectively. There was no difference in the risk of 30-day mortality or the duration of hospitalization. There was no change in the effect on subgroup analysis of studies using OTSC as first-line therapy. Conclusion The use of OTSC can reduce the rebleeding rates after endoscopic hemostasis. However, they may not reduce the risk of persistent bleeding or mortality. Future studies are required on the cost-efficacy of this modality.

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“…2 shows the traffic-light plot to assess the risk of bias. The risk of bias was low in three 10 13 14 and medium in two studies. 11 12…”

Section: Resultsmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 98%

Section: Study Characteristics and Assessment Of The Risk Of Biasmentioning

confidence: 99%

Section: Study Characteristics and Assessment Of The Risk Of Biasmentioning

confidence: 99%

See 2 more Smart Citations

Efficacy of Over-the-Scope Clips Compared to Standard Therapy for Nonvariceal Upper Gastrointestinal Bleeding—A Systematic Review and Meta-analysis of Randomized Trials

Giri,

Harindranath,

Kozyk

et al. 2023

Journal of Digestive Endoscopy

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“…While some studies have demonstrated the effectiveness of each hemostatic method, [28,29] few studies have compared their effects on hemostasis. [30][31][32] In this study, owing to uncontrolled variables and the varying choice of hemostatic method based on the severity and extent of bleeding, the direct comparison of rebleeding rates according to the hemostatic methods was Considering the profound relationship between rebleeding and mortality, further studies may be necessary to analyze the hemostatic effects of the different hemostatic methods.…”

Section: Discussionmentioning

confidence: 99%

Comparison and validation of the Japanese score and other scoring systems in patients with peptic ulcer bleeding: A retrospective study

Kim,

Moon,

Choi

et al. 2023

Medicine

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Acute upper gastrointestinal bleeding (UGIB) is one of the most urgent medical conditions, with peptic ulcer bleeding (PUB) accounting for most gastrointestinal bleeding cases. The Japanese scoring system was developed to predict the probability of intervention in patients with UGIB, and it is more effective than other scoring systems, according to several studies. This study aimed to verify whether the Japanese scoring system is better than other scoring systems in predicting the probability of intervention when limited to PUB in patients with UGIB. We enrolled patients who presented with symptoms of UGIB and were diagnosed with peptic ulcers using endoscopy. The performances of the scoring systems in predicting patient outcomes were validated and compared using the receiver-operating characteristic curve analysis. Additionally, we used the chi-square test, Fisher exact test, and the t test to analyze the association between the patients characteristics and clinical outcomes. Of the 1228 patients diagnosed with peptic ulcers, 90.6% underwent endoscopy. rebleeding occurred in 12.5% of the patients, and 2.5% of the patients died within 30 days. The Japanese score was the most effective in predicting the need for endoscopic intervention for PUB. Sex, systolic blood pressure, hematemesis, syncope, blood urea nitrogen level, and the American Society of Anesthesiologists score were predictive factors for the probability of endoscopic intervention in patients with PUB. The Japanese score is an effective predictor of the probability of endoscopic intervention in patients with PUB.

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Blue Laser Triggered Hemostatic Peptide Hydrogel for Gastrointestinal Bleeding Treatment

Luo,

Luan

et al. 2024

Advanced Materials

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In an emergency, nonvariceal upper gastrointestinal bleeding (NVUGIB), endoscopic hemostasis is considered the gold standard intervention. However, current endoscopic hemostasis is very challenging to manage bleeding in large‐diameter or deep lesions highly prone to rebleeding risk. Herein, a novel hemostatic peptide hydrogel (HPH) is reported, consisting of a self‐assembly peptide sequence CFLIVIGSIIVPGDGVPGDG (PFV) and gelatin methacryloyl (GelMA), which can be triggered by blue laser endoscopy (BLE) for nonvariceal upper gastrointestinal bleeding treatment without recurring bleeding concerns. Upon contact with GelMA solution, PFV immediately fibrillates into β‐sheet nanofiber and solvent‐induced self‐assembly to form HPH gel. HPH nanofiber networks induced ultrafast coagulation by enveloping blood cells and activating platelets and coagulation factors even to the blood with coagulopathy. Besides its remarkable hemostatic performance in artery and liver injury models, HPH achieves instant bleeding management in porcine NVUGIB models within 60 s by preventing the rebleeding risk. This work demonstrates an extraordinary hemostatic agent for NVUGIB intervention by BLE for the first time, broadening potential application scenarios, including patients with coagulopathy and promising clinical prospects.

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Comparison of Over-the-Scope Clips to Standard Endoscopic Treatment as the Initial Treatment in Patients With Bleeding From a Nonvariceal Upper Gastrointestinal Cause

Cited by 18 publications

References 15 publications

Efficacy of Over-the-Scope Clips Compared to Standard Therapy for Nonvariceal Upper Gastrointestinal Bleeding—A Systematic Review and Meta-analysis of Randomized Trials

Efficacy of Over-the-Scope Clips Compared to Standard Therapy for Nonvariceal Upper Gastrointestinal Bleeding—A Systematic Review and Meta-analysis of Randomized Trials

Comparison and validation of the Japanese score and other scoring systems in patients with peptic ulcer bleeding: A retrospective study

Blue Laser Triggered Hemostatic Peptide Hydrogel for Gastrointestinal Bleeding Treatment

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