| Objective:To investigate the effectiveness of over-the-scope clip(OTSC)in the treatment of peptic ulcer hemorrhage,To comparatively analyze the clinical outcome of OTSC and through-the-scope clip in the treatment of peptic ulcer hemorrhage after Rockall risk score system stratifying.And to provide endoscopic physicians a reference in choosing OTSC or through-the-scope clip to perform endoscopic hemostasis according to the Rockall score.Methods:A total of 69 hospitalized patients with peptic ulcer bleeding and had through-the-scope clip hemostasis from January 2013 to June 2015 in Department of Gastroenterology,Southeast Hospital Affiliated to Xiamen University were included.And 90 cases of patients diagnosed with peptic ulcer bleeding and had OTSC hemostasis in our department from July 2015 to January 2018 were enrolled.The patients were thus in the OTSC group and in the through-the-scope clip group respectively.Patients' general information,medical history data,laboratory test results,endoscopic findings,endoscopic hemostasis,and treatment outcomes were registered.According to the Rockall score system,patients were further stratified into three different risk level groups,low-risk,moderate-risk and high-risk,and data were analyzed comparatively in the same risk level group.SPSS20.0 was used for data statistics and analysis.Results:A total of 159 patients with peptic ulcer hemorrhage were enrolled in this study,including 127 male and 32 female,57 elderly patients and 102 non-elderly patients;there were 25 patients who had taken anticoagulants and non-steroidal anti-inflammatory drugs,and 72%(18/25)were elderly patients.There were 43 people with Rockall score low-risk,and 58 people with moderate-risk and high-risk respectively.The main symptoms of peptic ulcer bleeding in this study were "melena"and "melena with vomiting blood".The comparison of the success rates of the two hemostatic clips showed that:in the low-risk group,the success rate and clinical success rate of the two methods for the treatment of peptic ulcer hemorrhage were 100%;in the moderate-risk group,the technical success rate of the OTSC subgroup was 97.1%(34/35),and the clinical success rate was 91.4%(32/35);while the technical success rate of the through-the-scope clip subgroup was 82.6%(19/23),and the clinical success rate was 65.2%(15/23);in the high-risk group,the technical success rate of the OTSC subgroup was 100%(38/38),and the clinical success rate was 94.7%(36/38);while the technical success rate of through-the-scope clip subgroup was 90%(18/20),and the clinical success rate was 70%(14/20).In the moderate-risk group and high-risk group,there was no statistical difference in the technical success rate between the OTSC subgroup and the through-the-scope clip subgroup,but the clinical success rates of the two hemostasis methods were statistically different(P<0.05).The clinical success rate of the OTSC subgroup was higher than that of the through-the-scope clip subgroup.According to the correlation analysis between Forrest classification and rebleeding rate,the higher the Forrest level,the higher is the risk of ulcer rebleeding.In this study,patients with rebleeding accounted for 28.6%for Forrest la,20.4%for Forrest ?b,7.1%for Forrest ?a,and 3.2%for Forrest#b.Comparative study of hospital stay showed that in the low-risk group,length of stay of patients treated with OTSC was 8.42±3.82 days,while that of patients treated with through-the-scope clip was 8.6512.15 days;in the moderate-risk group,the length of stay was 8±3.85 days for those who were treated with OTSC,while 11±2.16 days for those who were treated with through-the-scope clip;In the high-risk group,the length of stay was 9.61±5.56 days for hemostasis with an OTSC,while13.1±5.5 days for patients treated with through-the-scope clip.The statistical comparison showed that there was a significant difference between the length of stay of the two hemostatic methods in the same Rockall score risk group(P<0.05).And the application of OTSC in the treatment of peptic ulcer bleeding can shorten the length of stay.The hospital cost comparison study showed that the average cost for patients with low-risk Rockall score and treated with OTSC was 26957±4754 Yuan,while the average cost for patients treated with through-the-scope clip hemostasis was 11491 ±2946 Yuan.The mean hospital cost for patients with OTSC hemostasis in the moderate-risk group was 27353±7535 Yuan,while the average cost for patients with through-the-scope clip hemostasis was 17281±10445 Yuan.The average hospitalization cost for high-risk group patients with OTSC hemostasis was 34268±14497 Yuan,and the average hospitalization cost for patients with through-the-scope clip hemostasis was 26640±21812 Yuan.The statistical comparison showed that the average hospital cost of the two hemostasis methods in the same risk group were statistically different(P<0.05),and the use of OTSC significantly increased the patient's hospitalization cost.A comparative study of blood transfusions showed that the rate of blood transfusion in the low-risk group was 47.1%(8/17)in the OTSC subgroup,and the transfusion rate was 57.7%(15/26)in the through-the-scope clip subgroup.There was no statistical difference between the two methods of hemostasis(P>0.05).In the moderate-risk group,the transfusion rate of patients treated with OTSC was 40%(14/35),while the transfusion rate of through-the-scope clip subgroup was 69.6%(16/23).There was a significant differences in the blood transfusion rates between the two hemostasis methods(P<0.05).The transfusion rate of peptic ulcer hemorrhage treated with OTSC was significantly lower than that of through-the-scope clip hemostasis.The transfusion rate of high-risk group and treated with OTSC hemostasis was 71.1%(27/38),and 85%(17/20)in through-the-scope clip hemostasis group.There was no statistical difference in transfusion rates between the two hemostasis methods(P>0.05).Conclusion:1.Peptic ulcer bleeding has a higher prevalence in males than in females.The incidence of non-elderly patients is higher than that of older patients.Most of the patients were admitted to hospital with "melena" as their main symptoms.2.For patients with peptic ulcer hemorrhage with low Rockall score,through-the-scope clip hemostasis can reduce the economic burden.3.Patients in the same risk stratification had shorter hospital length of stay with OTSC hemostasis than that of with through-the-scope clip hemostasis.Therefore,the OTSC can reduce hospital stay and speed up turnover rate.4.According to the Rockall score,patients with peptic ulcer bleeding were stratified by the risk of bleeding in the early stage.For patients with moderate-risk group,use OTSC hemostasis is recommended to reduce the need for blood transfusion.It can reduce the risk of blood-borne diseases,and it can also help alleviate the current shortage of blood resources.From the economic point of view,it can also reduce the medical cost of blood transfusions.5.The OTSC can safely and permanently stop bleeding,and it can also be used as the first-line treatment for Rocall score high-risk patients.6.Effectively assessing the patient's condition and risk is very important,and reasonable treatment is the basis of reducing medical costs and improving prognosis. |
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