Analysis Of 36 Cases Of Non-variceal Upper Gastrointestinal Bleeding Treated With Over-the-scope-clip

ObjectivesTo analyze the clinical features of patients with non-variceal upper gatrointestinal bleeding(NVUGIB)treated with the over-the-scope clip(OTSC).MethodsThe clinical data of NVUGIB patients treated with the OTSC from February 2016 to February 2019 in the Endoscopic Center of the First Affiliated Hospital of Fujian Medical University were collected and analyzed retrospectively.ResultsA total of 36 cases were included.Among them,peptic ulcer accounted for 77.8%(28/36),Dieulafoy disease was 6.5%(2/36),gastric malignant tumor was 3.2%(1/36),Mallory-Weiss syndrome was 6.5%(2/36),postoperative endoscopic submucosal dissection was 3.2%(1/36),and the saddle ulcer of remnant stomach was 6.5%(2/36).According to the ROC curve,the Rockall risk score ?7 was found to be the best critical point for re-bleeding after treatment.In the Rockall risk assessment,55.56%(20/36)were high risk(? 7)and 16(16/36)were low risk(<7).The initial success rate of NVUGIB treated with the OTSC was 94.4%(34/36),and the clinical success rate was 80.6%(29/36).The endoscopic findings with severed vessels(Forrest Ia?Forrest IIa)were found in,39.3%(11/28)of the patients,which was related to a higher rebleeding rate when compared to those without severed vessels after OTSC treatment(36.4% vs 5.9%,P=0.040)..In low risk group,the incidence of rebleeding occurred in patients with severed vessels accounted for 66.7% of the total rebleeding events.The occurrence of rebleeding and bleeding-related mortality were significantly lower in the high risk group when compared to the Rockall study(20% vs 46.8%,0% vs 22.3%,respectively,P<0.05,both),OTSC was applied as first-line(19.4%,7/36)or salvage(80.6%,29/36)treatment,whlie no difference in rebleeding rates was found between the groups(17.2% vs 28.6%,P=0.883).However,the average hospitalization day in first-line treatment group was shorter than salvage group(9.1 days vs 16.3 days,P=0.003).All patients were followed up for 1 month,and no additional rebleeding or treatment-related complications were found.Eight patients were followed up by endoscopy with mean duration of 11.5 months,and no complications were observed,OTSCs were detached in 75%(6/8)of patients during the follow up.ConclusionsWhen the Rockall risk score was ? 7,the choice of the OTSC was beneficial to improve the prognosis,and the selection of the OTSC as the first-line treatment could significantly reduce hospitalization days.The risk of rebleeding after OTSC in low-risk patients with the Rockall risk score should be evaluated in combination with the Forrest classification and endoscopic hemostatic technique should be used if necessary.