In a randomized controlled trial, over-the-scope clips outperformed through-the-scope clips in terms of technical and overall clinical success rates in people suffering from suspected upper gastrointestinal bleeding. For first-line endoscopic therapy of acute peptic ulcer bleeding, researchers compared the efficacy of through-the-scope clips with over-the-scope clips.

In this international, multi-center study, volunteers who had upper gastrointestinal bleeding were incorporated. Subjects with Forrest Ia-IIb gastroduodenal peptic ulcer were randomly allocated to receive either through-the-scope clips or over-the-scope-clip therapy. Thirty-day rebleeding, technical success, and overall clinical success rates (characterized as technical success without proof of thirty-day rebleeding) were the major endpoints.

Out of 251 individuals screened, 112 patients were randomly assigned to receive therapy with the through-the-scope clips (n = 51) or the over-the-scope clip (n = 61). Technical success was attained in 98.4% (60/61) of volunteers treated with over-the-scope clip and in 78.4% (40/51) of people treated with through-the-scope clips, respectively. Failure of through-the-scope clips was associated with posterior duodenal wall location (3/11), large-size visible bleeding vessel (1/11), and fibrotic peptic ulcer (7/11).

After achieving technical success, 1.7% (1/60) and 5.0% (2/40) of the patients treated with the over-the-scope clip and through-the-scope clips had 30-day rebleeding, respectively. In the over-the-scope clip group, the overall clinical success rate was 96.7% (59/61) as opposed to 74.5% (38/51) in the through-the-scope clips group. As first-line endoscopic therapy for acute peptic ulcer bleeding, over-the-scope clips exhibited superior efficacy as compared to through-the-scope clips.