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©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 7, 2016; 22(41): 9162-9171
Published online Nov 7, 2016. doi: 10.3748/wjg.v22.i41.9162
Published online Nov 7, 2016. doi: 10.3748/wjg.v22.i41.9162
First-line endoscopic treatment with over-the-scope clips significantly improves the primary failure and rebleeding rates in high-risk gastrointestinal bleeding: A single-center experience with 100 cases
Hans-Jürgen Richter-Schrag, Christine Walker, Andreas Fischer, Robert Thimme, Center of Interdisciplinary Gastrointestinal Endoscopy, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, D-79106 Freiburg, Germany
Torben Glatz, Department of General and Visceral Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, D-79106 Freiburg, Germany
Author contributions: Richter-Schrag HJ designed the research and wrote the paper; Glatz T performed and analyzed the data; Walker C and Fischer A contributed to the evaluation; Thimme R critically revised the manuscript.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board and the Ethics Committee of Albert-Ludwigs-University-Freiburg, Germany.
Informed consent statement: All study participants, or their legal guardians, provided informed written consent prior to study enrollment and treatment. The identity of all subjects, including all details, was anonymized.
Conflict-of-interest statement: The authors declare that there is no conflict of interest with the paper presented.
Data sharing statement: No additional data are available. Informed consent for data sharing was not obtained, but the present data are anonymized, and the risk of identification is low. Questions regarding the technical aspects and data set are available from the corresponding author at hans-juergen.schrag@uniklinik-freiburg.de.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hans-Jürgen Richter-Schrag, MD, Professor of Medicine, Center of Interdisciplinary Gastrointestinal Endoscopy, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Street 55, D-79106 Freiburg, Germany. hans-juergen.schrag@uniklinik-freiburg.de
Telephone: +49-761-27032020 Fax: +49-761-27027750
Received: June 18, 2016
Peer-review started: June 21, 2016
First decision: July 12, 2016
Revised: August 1, 2016
Accepted: September 28, 2016
Article in press: September 28, 2016
Published online: November 7, 2016
Peer-review started: June 21, 2016
First decision: July 12, 2016
Revised: August 1, 2016
Accepted: September 28, 2016
Article in press: September 28, 2016
Published online: November 7, 2016
Core Tip
Core tip: In the present study, the over-the-scope clip (OTSC) was evaluated for first-line and second-line endoscopic treatment (FLET, SLET) of high-risk upper and lower gastrointestinal bleeding. One hundred OTSCs were applied in 93 patients. Primary hemostasis and clinical success was achieved in 88% and 78%, respectively. Statistical analysis shows no significant influence of anticoagulants on the rebleeding rate. The total mortality was 21.5%. Primary failure was significantly reduced by the use of OTSC as FLET (4.9% vs 23.1%, P = 0.008). This largest single-center data of OTSC-placement in high-risk GI bleeding published to date shows, for the first time, that FLET is a significant predictor of reduced rebleeding (OR = 5.2; P = 0.009).