Mo1115 IS OVER-THE-SCOPE-CLIP AN EFFECTIVE RESCUE THERAPY FOR SEVERE ACUTE UPPER GASTROINTESTINAL BLEEDING EVEN IN VARICEAL ONES?

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When repeated endoscopic therapy fails to achieve hemostasis for acute upper GI bleeding, current treatment options have been limited to surgery or angiography with embolization. Over-the-scope-clip (OTSC) has potency to achieve haemostasis of various bleeding GI lesions. We aimed that to critize the usefulness and safety of OTSC for achieve endoscopic hemostasis in patients who failed repeated endoscopic methods. Case series of patients who have serious upper GI bleeding undergoing endoscopic hemostasis using OTSC was evaluated. The OTSC-system was loaded on the scope and then the lesion was suctioned into the transparent cap before releasing the clip. Grasping forceps were not used. All patients underwent second look endoscopy after the procedure on first and fourth days. Primary hemostasis success, recurrent bleeding rate, complications, and 1-month follow-up clinical outcomes analyzed. During a 24-months period, 15 consecutive patients were evaluated (10 male) with a mean age of 31 (range 22-79) years, a mean hemoglobin of 9 (range 6 to 11) g/dl. All patients had received packed red blood cells with the mean being 3 (range 4- 9) units. All patients had failed hemostatic therapy using current available endoscopic methods. The mean number of endoscopies performed on these patients prior to OTSC was 3 (range 3-5). Reasons for bleeding in patients were as follows: Dieulafoy lesion (n=5), duodenal ulcer (n=3), anastomotic varices (n=2), fibrotic esophageal varices (n=2), fundic varices and anastomotic ulceration (n=1). All patients achieved immediate hemostasis. Re-bleeding occurred in only one patient (fundic varices) 72 hours after OTSC. Subsequently, this patient successfully treated with synthetic surgical glue injection. No adverse event related to OTSC application was observed. OTSC is a safe endoscopic treatment method that can be easily applied to control serious acute GI bleeding even in variceal ones when single or combined current endoscopic treatments are unsuccessful. Its use for fundic varices can be considered as a bridge to standardized synthetic surgical glue injection therapy, until its superiority would be demonstrated by prospective studies in this patient population