Background and Aims

Upper GI bleeding (UGIB) is a common condition associated with significant morbidity and mortality. Endoscopic hemostasis remains the mainstay of therapy and is mainly aimed at effective hemostasis and prevention of rebleeding. Lesions with high-risk stigmata can have rebleeding rates of as high as 26.3%. Rebleeding is associated with increased mortality and reduced success rates of endoscopic retreatment. The over-the-scope-clip (OTSC) is a device with widespread endoscopic indications including hemostasis for nonvariceal UGIB (NVUGIB). The current study presents a systematic review and meta-analysis comparing OTSCs versus standard therapy (STD) for NVUGIB.

Methods

Multiple databases were searched through April 2022 for studies comparing OTSCs and STD for NVUGIBs. Primary outcomes were clinical success rates, rebleeding rates, and procedure times, and secondary outcomes were mortality rates and length of hospitalization. Meta-analysis was performed to determine pooled odds ratios to compare outcomes between the OTSC and STD groups.

Results

Ten studies, including 4 randomized controlled trials, with 914 patients were included in the final analysis. Of patients with NVUGIB, 431 were treated with OTSCs and 483 with STD. Patients treated with OTSCs had an overall lower risk of 7-day (risk ratio [RR], .41; 95% confidence interval [CI], .24-.68; I² = 0%) and 30-day rebleeding (RR, .46; 95% CI, .31-.65; I² = 0%). Clinical success rates were higher with OTSCs compared with STD (RR, 1.36; 95% CI, 1.06-1.75). Mean procedure time was shorter in the OTSC group by 6.62 minutes (95% CI, 2.58-10.67) versus the STD group (I² = 84%). There was no statistically significant difference in terms of mortality between the OTSC and STD groups (RR, .55; 95% CI, .24-1.24; I² = 0%). Length of hospitalization was comparable between both groups, with a pooled mean difference for OTSCs versus STD of .87 days (95% CI, –1.62 to 3.36 days; I² = 71%).

Conclusions

Although our study was limited to high-risk NVUGIB, our analysis showed that hemostasis with OTSCs is associated with a lower 7-day and 30-day rebleeding rates, higher clinical success rates, and shorter procedure time with similar mortality rates and length of hospital stay as compared with STD.

中文翻译：

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对于高危非静脉曲张性上消化道出血，超范围夹与标准疗法的安全性和有效性：系统评价和荟萃分析

背景和目标

上消化道出血 (UGIB) 是一种与显着发病率和死亡率相关的常见疾病。内镜下止血仍然是治疗的主要手段，主要目的是有效止血和预防再出血。具有高风险圣痕的病变的再出血率可高达 26.3%。再出血与死亡率增加和内镜再治疗成功率降低有关。超范围夹 (OTSC) 是一种具有广泛内镜适应症的设备，包括非静脉曲张 UGIB (NVUGIB) 的止血。目前的研究对 NVUGIB 的 OTSC 与标准疗法 (STD) 进行了系统评价和荟萃分析。

方法

在 2022 年 4 月之前搜索了多个数据库，以寻找比较 OTSC 和 STD 与 NVUGIB 的研究。主要结果是临床成功率、再出血率和手术时间，次要结果是死亡率和住院时间。进行荟萃分析以确定汇总优势比，以比较 OTSC 和 STD 组之间的结果。

结果

最终分析纳入了 10 项研究，包括 4 项随机对照试验，共有 914 名患者。在 NVUGIB 患者中，431 名接受 OTSC 治疗，483 名接受 STD 治疗。接受 OTSC 治疗的患者在 7 天（风险比 [RR]，0.41；95% 置信区间 [CI]，0.24-.68；I ²  = 0%）和 30 天再出血（RR , .46; 95% CI, .31-.65; I ²  = 0%)。与 STD 相比，OTSC 的临床成功率更高（RR，1.36；95% CI，1.06-1.75）。OTSC 组的平均手术时间比 STD 组短 6.62 分钟（95% CI，2.58-10.67）（I ²  = 84%）。OTSC 组和 STD 组之间的死亡率没有统计学上的显着差异（RR，0.55；95% CI，0.24-1.24；我²  = 0%)。两组的住院时间相当，OTSC 与 STD 的平均差异为 0.87 天（95% CI，–1.62 至 3.36 天；I ²  = 71%）。

结论

尽管我们的研究仅限于高危 NVUGIB，但我们的分析表明，使用 OTSC 进行止血与较低的 7 天和 30 天再出血率、较高的临床成功率和较短的手术时间相关，而死亡率和住院时间相似与 STD 相比。