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Review
. 2025 Oct;40(10):2373-2390.
doi: 10.1111/jgh.70022. Epub 2025 Jul 30.

Over-the-Scope Clip Versus Standard Endoscopic Treatment in Patients With Acute Nonvariceal Upper Gastrointestinal Bleeding: A Systematic Review and Meta-Analysis

Jin Hean Koh  1 , Oh Anna  1 , Joseph Jing Rong Teng  1 , Rajesh R  2 , Ravishankar Asokkumar  2 , Rungsun Rerknimitr  3 , Andrew Fu Wah Ho  4   5   6 , Daniel Yan Zheng Lim  2   6   7
Affiliations
Review

Over-the-Scope Clip Versus Standard Endoscopic Treatment in Patients With Acute Nonvariceal Upper Gastrointestinal Bleeding: A Systematic Review and Meta-Analysis

Jin Hean Koh et al. J Gastroenterol Hepatol. 2025 Oct.

Abstract

Introduction: The over-the-scope clip (OTSC) system is an endoscopic device for treatment of acute nonvariceal upper gastrointestinal bleeding (NVUGIB). It is often used as salvage treatment in cases of failure of standard endoscopic treatment. It is unclear whether OTSC is superior to standard endoscopic treatment as first-line treatment for acute NVUGIB, in terms of rebleeding and mortality. The objective of this meta-analysis is to compare the efficacy and safety of OTSC versus standard endoscopic treatment as first-line treatment for acute nonvariceal upper gastrointestinal bleeding.

Methods: Following a PROSPERO-registered protocol, three blinded reviewers performed a systematic review for studies that compared the use of OTSC with standard endoscopic treatment as first-line treatment for acute NVUGIB from inception to October 2024. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework. A meta-analysis was conducted in risk ratios and the mean difference.

Results: From 14 studies of which five were RCTs (7211 patients), OTSC was associated with significantly lower rates of 30-day rebleeding (RR: 0.44, 95% CI: 0.32 to 0.61, p < 0.01, I2 = 0%), 7-day rebleeding (RR: 0.50, 95% CI: 0.35 to 0.71, p < 0.01, I2 = 0%), and 30-day mortality (RR: 0.47, 95% CI: 0.33 to 0.67, p = 0.01, I2 = 0%) compared with standard endoscopic treatment. OTSC was also associated with significantly higher overall clinical success rates (RR: 1.16, 95% CI: 1.09 to 1.24, p < 0.01, I2 = 0%) and significantly lower procedural time (MD: -6.80, 95% CI: -12.53 to -1.07, p = 0.02, I2 = 81%) compared with standard endoscopic treatment.

Conclusions: OTSC may represent a safe and effective alternative to standard endoscopic treatment for acute NVUGIB. Further large, randomized trials are warranted to confirm these findings.

Keywords: clips; endoscopy; hematemesis; melena; peptic ulcer.

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References

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