Esophagus to Small Intestine

Gut. 2022;71(7):1251–8

Meier B, Wannhoff A, Denzer U, Stathopoulos P, Schumacher B, Albers D, Hoffmeister A, Feisthammel J, Walter B, Meining A, Wedi E, Zachäus M, Pickartz T, Küllmer A, Schmidt A, Caca K

Over-the-scope clips versus standard treatment in high-risk patients with acute non-variceal upper gastrointestinal bleeding: A randomized controlled trial (STING-2)

Objective: Acute non-variceal upper gastrointestinal bleeding (UGIB) is managed by standard endoscopic combination therapy, but a few cases remain difficult and carry a high risk of persistent or recurrent bleeding. The aim of the present study was to compare first-line over-the-scope clips (OTSC) therapy with standard endoscopic treatment in these selected patients.
Design: The authors conducted a prospective, randomized, controlled, multicenter study. Patients with endoscopic evidence of acute non-variceal UGIB and high risk of rebleeding (defined as complete Rockall Score ≥ 7) were included. Primary end point was clinical success defined as successful endoscopic hemostasis without evidence of recurrent bleeding.
Results: 246 patients were screened and 100 patients were finally randomized (mean of 5 cases/center and year; 70% male, 30% female, mean age 78 years; OTSC group, n = 48; standard group, n = 52). All but 1 case in the standard group were treated with conventional clips. Clinical success was 91.7% (n = 44) in the OTSC group compared with 73.1% (n = 38) in the standard treatment group (p = 0.019), with persistent bleeding occurring in 0 versus 6 in the OTSC versus standard group (p = 0.027), all of the latter being successfully managed by rescue therapy with OTSC. Recurrent bleeding was observed in 4 patients (8.3%) in the OTSC group and in 8 patients (15.4%) in the standard group (p = 0.362).

Conclusion: Over-the-scope clips (OTSC) therapy appears to be superior to standard treatment with clips when used by trained physicians for selected cases of primary therapy of non-variceal upper gastrointestinal bleeding with high risk of rebleeding. Further studies are necessary with regards to patient selection to identify subgroups benefiting most from OTSC hemostasis.

Prof. Dr. K. Caca, Klinik für Innere Medizin, Gastroenterologie, Hämato-Onkologie, Diabetologie und Infektiologie, Klinikum Ludwigsburg, Ludwigsburg, Germany,

DOI: 10.1136/gutjnl-2021-325300

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