P3082 - Over-the-Scope Clips Halve 30-Day Clinical Failure Without Extra Rescue Therapy in High-Risk Peptic-Ulcer Bleeding: A Contemporary Systematic Review and Meta-Analysis of Randomized Controlled Trials

Ashesh Das, MBBS¹, Venkata Dileep Kumar Veldi, MBBS², Fazia Khattak, ³, Akif Shahid. Khan, MBBS⁴, Siddenthi Shreya, MBBS⁵, Nihal Reddy, MBBS⁶, Hari Krishna Akurathi, ⁷, Aparna Malireddi, MBBS⁸, Erukulla Rishitha Santoshi, MBBS⁹, Komuroju Pooja. Mrinmai, MBBS¹⁰, Pulumati Keerthana, MBBS¹¹, Vishnu Pappu, MBBS¹², Tejaswin Mariappan, MBBS¹³, P Aravind Sai Reddy, MBBS¹⁴
1KPC Medical College and Hospital , Kolkata, India, Kolkata, West Bengal, India; 2Gayatri Vidya Parishad Institute of Health care and Medical Technology, Visakhapatnam, Andhra Pradesh, India; 3Khyber Medical College, Peshawar, North-West Frontier, Pakistan; 4Northwest School of Medicine, Nowshera, North-West Frontier, Pakistan; 5ESIC Medical College and Hospital, Hyderabad, Telangana, India; 6ESIC Medical College and Hospital Sanathnagar, Hyderabad, Telangana, India; 7NRI MEDICAL COLLEGE, Gudivada, Andhra Pradesh, India; 8Andhra Medical College, Visakhapatnam, Andhra Pradesh, India; 9Kakatiya medical college, Warangal, Telangana, India; 10Dr patnam mahender reddy medical College, chevella, Manthani, Telangana, India; 11SVS Medical College and Hospital, Hyderabad, Telangana, India; 12Kakatiya Medical College - Warangal., Hyderabad, Telangana, India; 13Stanley Medical College, Salem, Tamil Nadu, India; 14Gadag Institute of Medical Sciences, Bangalore, Karnataka, India

Introduction: Over-the-scope clips (OTSC) offer a promising solution for achieving single-device, suture-strength closure in challenging non-variceal upper gastrointestinal bleeding cases. However, the widespread application of OTSC has surpassed the availability of high-level evidence to support its efficacy. Prior reviews have focused solely on technical success and initial hemostasis. This study addresses this critical gap in the literature, as OTSC has already been included in various international treatment protocols. We present the first meta-analysis limited to randomized trials, specifically designed to evaluate guideline-relevant, patient-centered outcomes.

Methods: A systematic search of PubMed, Embase, Scopus, and Cochrane Library identified Randomized Controlled Trials (RCTs) comparing over the scope clips with conventional through-the-scope clips ± adjuvant therapy through May 2025. Data were analysed using RevMan 4.2.1. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using Mantel-Haenszel methods. Random- or fixed-effects models were applied based on heterogeneity (Higgins’ I²). Statistical significance was set at p < 0.05. Risk of bias was assessed using RoB 2.0.

Results: OTSC reduced clinical failure by 59 % (13/184 vs 33/181; RR 0.41, 95 % CI 0.22–0.75; p = 0.004) 11 % absolute risk reduction and number-needed-to-treat of nine. Rates of rescue therapy were similar (14/184 vs 12/181; RR 1.07, 0.52–2.20), refuting concerns that upfront OTSC merely postpones escalation. Thirty-day mortality was low but numerically favoured OTSC (6/159 vs 12/153; RR 0.49, 0.19–1.27). All trials achieved 100 % technical deployment with no clip-related perforations.

Discussion: This meta-analysis using only RCTs delivers the first precise, patient-centred estimate of OTSC benefit i.e a halving of clinical failure without extra downstream procedures and a possible survival advantage. Uniform endpoints and zero heterogeneity make the data guideline-ready. Sparing one in nine patients from re-bleeding translates into fewer transfusions, ICU stays and bed-day costs that leads to tangible gains for resource-stretched endoscopy units. These data provide a rationale for OTSC to be considered as a first-line option and should inform future guideline updates.


Figure: Forest Plot Showing 30 Days Mortality, Clinical Success Rate and Need for Reintervention


Figure: Prisma Flowchart

Disclosures:
Ashesh Das indicated no relevant financial relationships.
Venkata Dileep Kumar Veldi indicated no relevant financial relationships.
Fazia Khattak indicated no relevant financial relationships.
Akif Khan indicated no relevant financial relationships.
Siddenthi Shreya indicated no relevant financial relationships.
Nihal Reddy indicated no relevant financial relationships.
Hari Krishna Akurathi indicated no relevant financial relationships.
Aparna Malireddi indicated no relevant financial relationships.
Erukulla Rishitha Santoshi indicated no relevant financial relationships.
Komuroju Mrinmai indicated no relevant financial relationships.
Pulumati Keerthana indicated no relevant financial relationships.
Vishnu Pappu indicated no relevant financial relationships.
Tejaswin Mariappan indicated no relevant financial relationships.
P Aravind Sai Reddy indicated no relevant financial relationships.

Ashesh Das, MBBS¹, Venkata Dileep Kumar Veldi, MBBS², Fazia Khattak, ³, Akif Shahid. Khan, MBBS⁴, Siddenthi Shreya, MBBS⁵, Nihal Reddy, MBBS⁶, Hari Krishna Akurathi, ⁷, Aparna Malireddi, MBBS⁸, Erukulla Rishitha Santoshi, MBBS⁹, Komuroju Pooja. Mrinmai, MBBS¹⁰, Pulumati Keerthana, MBBS¹¹, Vishnu Pappu, MBBS¹², Tejaswin Mariappan, MBBS¹³, P Aravind Sai Reddy, MBBS¹⁴. P3082 - Over-the-Scope Clips Halve 30-Day Clinical Failure Without Extra Rescue Therapy in High-Risk Peptic-Ulcer Bleeding: A Contemporary Systematic Review and Meta-Analysis of Randomized Controlled Trials, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.