Over-the-scope clips versus standard therapy in upper gastrointestinal bleeding

We read with high interest the randomised controlled trial (RCT) of Chan et al investigating over-the-scope clips (OTSC) versus standard therapy for the prevention of rebleeding in large (≥1.5 cm) peptic ulcers.1 However, this study and some aspects of study design deserve further critical evaluation and interpretation. One hundred patients with peptic ulcer bleeding and lesion size ≥1.5 cm were randomised to OTSC or standard treatment. In the intention-to-treat analysis, the primary endpoint of clinical rebleeding within 30 days was achieved in 10% with OTSC vs 18% with standard therapy. The difference was statistically not significant. Two previously published RCTs assessing OTSC first-line therapy in non-variceal upper gastrointestinal (GI) bleeding have shown superiority to standard treatment.2 3 In both trials, only high-risk patients were included (eg, patients with haemodynamic instability or Rockall Score ≥7). The only selection criterium in the study of Chan et al...
Source: Gut - Category: Gastroenterology Authors: Tags: Gut PostScript Source Type: research