S3179 Over-the-Scope Clip vs Standard Endoscopic Hemostatic Therapy in Upper GI Bleeding: Meta-Analysis of Randomised Control Trials

Abstract

INTRODUCTION: Endoscopy hemostasis is an effective way to treat upper GI bleeding from causes like peptic ulcer disease, AVMs etc. However, recurrence of bleeding is also common and is associated with significant morbidity and mortality. The methods of hemostasis are adrenaline combined with through-the-scope clips (TTSCs) or thermal/heat methods which is also considered to be the standard endoscopic therapy (ST). Lately, Over-the-scope clips (OTSC) have been increasingly used for the treatment of severe upper gastrointestinal bleeding. We conducted a meta-analysis of randomized control trials (RCT) which compared ST vs OTSC for hemostasis in upper GI bleeding and risk of rebleeding. To our knowledge, this is the first meta-analysis that includes only RCT studies pertaining to this topic. METHODS: PubMed, Embase and Web of knowledge, reference lists of retrieved articles, and conference abstracts were searched for relevant studies (Search date May-2020). Only Randomized control studies were included. Standardized forms were used to extract data. Data was extracted by two reviewers independently. Statistical analysis was performed using Comprehensive Meta- analysis software. Heterogeneity and publication bias were also assessed. RESULTS: Only Two studies met our inclusion criteria. Pooled number of patients in ST group was 58 (sample size as 23-35) and in the OTSC group were 57 (Sample size as 24-33). Age ranged from 66-78 in both groups. Female gender ranged from 16 to 48% in ST group and 25% to 39.3% in OTSC group. The average blood transfusion required in ST was 3.2 (range 2-4) as compared to OTSC group was 2.4 (range 1.8-3). OTSC was associated with a lower rate of 30 days re-bleeding rate when compared with ST (RR 0.27, 95% CI 0.08-0. 82; P = 0.021). Other secondary endpoints including mortality, surgery, need for embolization were statistically not different in both groups. CONCLUSION: OTSC was associated with a lower 30-day re-bleeding rate as compared to ST.Figure 1