Introduction: Endoscopic hemostasis with hemoclips, thermal therapy and submucosal injections of epinephrine have been the standard of care for management of non-variceal upper GI bleed (NVUGIB). However, severe NVUGIB with stigmata of recent hemorrhage (SRH) patients can experience rebleeding in 25% patients. Recently, over-the-scope clips (OTSC) have been successfully used for management of severe NVUGIB. We conducted a systematic review and meta-analysis to compare the efficacy and safety of OTSC and standard endoscopic therapy (SET) for management of severe NVUGIB.
Methods: We searched several databases from inception through May 21, 2022 for randomized controlled trials (RCTs) comparing efficacy and safety of OTSC and SET for management of NVUGIB in terms of risks of further bleeding & mortality, units of blood required, duration of ICU and hospital stays. Pooled odds ratios (OR) and mean differences (MD) were calculated for categorical and continuous variables, respectively.
Results: Three RCTs with 219 patients (69 females) were included in the final analysis. Among these 106 were treated with OTSC and 113 with standard therapy. Pooled OR with 95% confidence interval (CI) for risk of further bleeding during next 30 days was 0.21 (0.10, 0.44), I2=14% in favor of OTSC. Number needed to treat for OTSC was 4. Pooled OR with 95% CI for mortality was 1.41 (0.49, 4.07), I2=0%. Likewise, there was no difference in length of hospital stay and ICU stays, pooled MD -1.40(-5.50, 2.69), I2=0% and 0.94 (-1.44, 3.32), I2=0%. However, OTSC group was associated with lower requirement of blood transfusion, pooled OR with 95% CI -0.53(-1.04,-0.02), I2=0%.
Discussion: OTSC was found to be superior than standard endoscopic therapy for management of severe NVUGIB in terms of risk of further bleeding and requirement of blood transfusions. There was no difference between the two in terms of mortality, duration of ICU and hospital stays.
