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P65 The ovesco OTSC for acute upper gastrointestinal bleeding – a large propensity score-matched UK series
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P65 The ovesco OTSC for acute upper gastrointestinal bleeding – a large propensity score-matched UK series
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P65 The ovesco OTSC for acute upper gastrointestinal bleeding – a large propensity score-matched UK series
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Journal Article
P65 The ovesco OTSC for acute upper gastrointestinal bleeding – a large propensity score-matched UK series
2021
Overview
IntroductionThere have been no significant improvements in the outcomes of upper gastrointestinal (GI) bleeding over the last few years. The aim of this study was to determine whether the use of the OVESCOTMover the scope clip (OTSC) was associated with a lower rebleed-rate and mortality compared to conventional endoscopic therapy.MethodsConsecutive episodes of upper GI haemorrhage treated with the OTSC were identified from a prospective database in a UK tertiary centre over a 3-year period. Treatment with OTSC was delivered for patients with high-risk features or failed conventional endoscopic therapy.Over the same time period, all patients with upper GI haemorrhage treated with conventional endoscopic therapy were retrospectively identified, and a propensity score-matched cohort was assembled. Patient demographics, 7-day re-bleed rate, 30-day re-bleed rate and 30-day mortality rates were compared. T-test and Pearson’s Chi-square statistic were used to statistically describe the results.Results617 episodes of upper GI haemorrhage were identified requiring endoscopic intervention over three years. 71 high-risk lesions were treated in the OTSC group, vs 89 high-risk lesions in the matched control group (conventional endoscopic therapy).The sites of lesions treated with the OTSC included oesophagus (10%), stomach (22%) and duodenum (68%). The lesions were described as Forrest 1a-18%, 1b-33%, 2a-32%, 2b-17%. Pathology included ulcers (78.9%), Mallory-Weiss tears (9.6%) Dieulafoy (7.0%) post-angiographic coil ulcer (1.4%) post- EMR (1.4%) anastomotic bleed (1.4%).Compared to the control group, the OTSC group had lower 7-day re-bleeding rate (19.3% vs 2.8%, p< 0.01) and a lower 30-day re-bleeding rate (25.0% vs 7.0%, p< 0.01). There was a trend toward reduction in all-cause mortality in the OTSC group (14.8% vs 8.5%, p=0.20) but a significantly lower haemorrhage related mortality in the OTSC group (4.5% vs 1.4%, p=0.02).ConclusionsThis is one of the largest series of patients treated with OTSC for upper GI haemorrhage, demonstrating a significant reduction in both early and late rebleeding in addition to haemorrhage related mortality and thus needs to part of the treatment armamentarium.
