Over-the-scope Clip Applications As First-line Therapy In The Treatment Of Upper Non-variceal Gastrointestinal Bleeding,Perforations,and Fistulas

Background and objective:The over-the-scope clip(OTSC)is an innovative endoscopic device and has been successfully used in the endoscopic treatment of various digestive tract diseases,however,due to the late introduction of OTSC system in China,there are few related studies in China at present.In addition,most studies have focused on the use of OTSC for rescue therapy,while the clinical data of OTSC as first-line treatment are limited.Therefore,the aim of this study is to investigate the OTSC applications as first-line therapy in the treatment of upper non-variceal gastrointestinal bleeding(UNVGIB),perforations and fistulas,in order to provide more clinical reference for the use of OTSC at home and abroad.Methods:The clinical date of 80 patients with UNVGIB,perforations and fistulas who received OTSC as first-line treatment in the endoscopic center of the First Affiliated Hospital of Nanchang University between January 2016 and November 2020 were retrospectively analyzed.The technical and clinical success rates were used to assessed the efficacy and safety of OTSC.Results:80 patients were all successfully treated with OTSC.The total technical success rate was 100%(80/80)and the total clinical success rate was 91.3%(73/80).The clinical success rates of OTSC in the treatment of UNVGIB,perforations and fistulas were 85.4%(35/41),100%(34/34)and 80%(4/5),respectively.For patients of Dieulafoy’s lesion and under antithrombotic therapy,we found that OTSC treatment both had efficient and reliable hemostasis effect.In addition,according to the characteristics of ulcers,site of bleeding lesion and Blatchford score,all patients received similar and reliable clinical success rates.In addition,none of the patients developed complications related to OTSC treatment.Conclusion:The OTSC represents a safe and effective endoscopic therapy for UNVGIB,perforations and fistulas as first-line treatment,especially for Dieulafoy’s lesion or patients under antithrombotic therapy for UNVGIB.However,OTSC application in these specific lesions or patients lacks adequate evidence as first-line treatment.Therefore,further larger sample and multi-center clinical trials are required to improve its indications in clinical treatment.