Meta-analysis Of The Efficacy And Safety Of OTSC In The Treatment Of Non-variceal Upper Gastrointestinal Bleeding

Objective:Upper gastrointestinal bleeding(UGIB)is a common disease associated with morbidity and mortality.Endoscopic hemostasis remains the mainstream of treatment,with the main goal of effectively stopping bleeding and preventing rebleeding.Rebleeding is associated with increased mortality and reduced success in secondary surgery.Over the scope clip(OTSC)is a widely applicable non-varicose vein UGIB(NVUGIB)treatment tool.Studies have shown that the success rate of OTSC hemostasis can reach 78%-100%,which is a safe and effective treatment measure for UGIB,so this article will conduct a comparative study on OTSC and standard endoscopic treatment to explore its efficacy and safety as a first-line treatment for NVUGIB.Methods:Following the methodology of the Cochrane systematic review,Medline,PubMed,Embase,Cochrane library and the full-text databases of Vipu,Wanfang,and Chinese journals were searched in silico,and all relevant randomized controlled trials,clinical trials and retrospective studies were collected by handsearch.After specifying exclusion criteria,studies were assessed for inclusion in RCTs using the Cochrane Manual for Evaluation,and retrospective studies were assessed using the Castle-Ottawa Scale(NOS),with studies of higher quality included.Using the software Revman 5.0 provided by the Cochrane Collaboration Network,metaanalysis was performed to calculate the combined OR or MD values and their 95%confidence intervals(CI),Z statistic and their probability values by selecting the corresponding pooled method through heterogeneity test results,to obtain evidence on whether OTSC as a first-line treatment differs from the standard endoscopic treatment in the treatment of gastrointestinal non-variceal bleeding.Results:Fifteen studies involving 1159 patients were included,including 8 RCTs and 7 retrospective cohort studies.Conclusions:1.Compared with the STD group,the OTSC group had a lower rebleeding rate at 7 days after surgery[P<0.0001,OR=0.26,95%CI(0.14-0.48)],and 30 days after surgery[p=0.0004,OR=0.39,95%CI(0.23,0.65)];2.The OTSC group had a shorter operation time than the STD group[P=0.02,OR=-7.14,95%CI(-13.26,-1.02)],and the difference was statistically significant;3.The OTSC group had a higher immediate hemostasis rate than the STD group[P<0.00001,OR=4.24,95%CI(2.42,7.43)];4.The OTSC group had a higher clinical effective rate than the STD group[P<0.0001,OR=4.79,95%CI(2.33,9.85)];5.However,there was no significant difference in length of hospital stay[P=0.06,OR=2.30,95%CI(-4.72,0.13)],transfusion volume[P=0.13,OR=-0.66,95%CI(-1.52,0.20)],complications[P=0.10,OR=0.27,95%CI(0.66,1.27)],and mortality[P=0.72,OR=0.85,95%CI(0.35,2.06)].Conclusion:OTSC is superior to standard endoscopic treatment in clinical efficacy,especially in reducing the rate of postoperative rebleeding,and the operation time is short,while there is no significant difference in the occurrence of postoperative adverse events and mortality,although the best treatment method is controversial.However,our statistical results support OTSC as a first-line treatment for nonvaricose bleeding in the UGIB.