For management of refractory peptic ulcer bleeding, over-the-scope clips therapy showed superiority to transcatheter arterial embolization in terms of in-hospital mortality and ICU stay.

A retrospective, multicenter sudy was carried out for comparing over-the-scope clips (OTSC) treatment vs. transcatheter arterial embolization (TAE) in peptic ulcer bleeding. 

The analysis incorporated 128 people managed with OTSC (n = 66) or TAE (n = 62) for refractory peptic ulcer bleeding of the upper gastrointestinal tract. The clinical success (hemostasis + no rebleeding within seven days) was the major outcome parameter while adverse events, length of intensive care unit (ICU) stay, and mortality were the secondary outcome parameters. For adjustment of the differences in the baseline characteristics, propensity score matching was executed.

Both the groups exhibited similar patient characteristics. However, ulcers in TAE-treated participants were much larger, and most commonly located in the duodenal bulb, and the percentage of Forrest Ia bleedings was more in TAE group. Clinical success was similar in both TAE and OTSC groups. The TAE group displayed longer ICU stay, higher serious adverse events after re-therapy and in-hospital death when compared to OTSC group (Table 1).

Following propensity score matching, the differences noted regarding ICU stay (4.9± 5.9 and 9.2 ± 11.2) and in-hospital death (5% vs. 22.5%) remained significant.

Endoscopic hemostasis with OTSC exhibits comparable technical and clinical success, but is linked with shorter ICU stay and minimized in‐hospital mortality in comparison with TAE for refractory peptic ulcer bleeding.