What Is the Current Role of an Over-the-Scope Clip Used as First-Line Endoscopic Hemostasis in Patients With Nonvariceal Upper Gastrointestinal Bleeding?
Bibliographic record
Abstract
EditorialsApril 2023What Is the Current Role of an Over-the-Scope Clip Used as First-Line Endoscopic Hemostasis in Patients With Nonvariceal Upper Gastrointestinal Bleeding?Alan N. Barkun, MD, MSc and Ali A. Alali, MBBCh, BAO, MScAlan N. Barkun, MD, MScDivision of Gastroenterology, McGill University and the McGill University Health Centre, Montreal, Quebec, Canada and Ali A. Alali, MBBCh, BAO, MScDepartment of Medicine, Faculty of Medicine, Kuwait University, Jabriyah, KuwaitAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M23-0449 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The management of patients with nonvariceal upper gastrointestinal bleeding (NVUGIB) has seen substantial evolution with the emergence of novel endoscopic methods—most recently the use of cap-mounted or over-the-scope clips (OTSCs) (1).In their article, Lau and colleagues (2) completed an important trial in patients with NVUGIB, this time assessing OTSCs. Over the past 5 years, 4 randomized controlled trials (RCTs) have compared OTSCs with standard endoscopic hemostasis in NVUGIB, all with some methodological limitations. A small RCT of 66 patients suggested the superiority of OTSCs in patients with recurrent NVUGIB in whom initial standard endoscopic approaches failed (3). Subsequent RCTs ...References1. Bapaye J, Chandan S, Naing LY, et al. Safety and efficacy of over-the-scope clips versus standard therapy for high-risk nonvariceal upper GI bleeding: systematic review and meta-analysis. Gastrointest Endosc. 2022;96:712-20.e7. [PMID: 35803307] doi:10.1016/j.gie.2022.06.032 CrossrefMedlineGoogle Scholar2. Lau JYW, Li R, Tan C, et al. Comparison of over-the-scope clips to standard endoscopic treatment as the initial treatment in patients with bleeding from a nonvariceal upper gastrointestinal cause. A randomized controlled trial. Ann Intern Med. 2023;176:455-62. doi:10.7326/M22-1783 LinkGoogle Scholar3. Schmidt A, Gölder S, Goetz M, et al. Over-the-scope clips are more effective than standard endoscopic therapy for patients with recurrent bleeding of peptic ulcers. Gastroenterology. 2018;155:674-86.e6. [PMID: 29803838] doi:10.1053/j.gastro.2018.05.037 CrossrefMedlineGoogle Scholar4. Jensen DM, Kovacs T, Ghassemi KA, et al. Randomized controlled trial of over-the-scope clip as initial treatment of severe nonvariceal upper gastrointestinal bleeding. Clin Gastroenterol Hepatol. 2021;19:2315-23.e2. [PMID: 32828873] doi:10.1016/j.cgh.2020.08.046 CrossrefMedlineGoogle Scholar5. Laine L, Barkun AN, Saltzman JR, et al. ACG clinical guideline: upper gastrointestinal and ulcer bleeding. Am J Gastroenterol. 2021;116:899-917. [PMID: 33929377] doi:10.14309/ajg.0000000000001245 CrossrefMedlineGoogle Scholar6. Gralnek IM, Stanley AJ, Morris AJ, et al. Endoscopic diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH): European Society of Gastrointestinal Endoscopy (ESGE) guideline - update 2021. Endoscopy. 2021;53:300-32. [PMID: 33567467] doi:10.1055/a-1369-5274 CrossrefMedlineGoogle Scholar7. Meier B, Wannhoff A, Denzer U, et al. Over-the-scope-clips versus standard treatment in high-risk patients with acute non-variceal upper gastrointestinal bleeding: a randomised controlled trial (STING-2). Gut. 2022;71:1251-8. [PMID: 35321938] doi:10.1136/gutjnl-2021-325300 CrossrefMedlineGoogle Scholar8. García-Iglesias P, Villoria A, Suarez D, et al. Meta-analysis: predictors of rebleeding after endoscopic treatment for bleeding peptic ulcer. Aliment Pharmacol Ther. 2011;34:888-900. [PMID: 21899582] doi:10.1111/j.1365-2036.2011.04830.x CrossrefMedlineGoogle Scholar9. Chan S, Pittayanon R, Wang HP, et al. Use of over-the-scope clip (OTSC) versus standard therapy for the prevention of rebleeding in large peptic ulcers (size ≥1.5 cm): an open-labelled, multicentre international randomised controlled trial. Gut. 2022. [PMID: 36307177] doi:10.1136/gutjnl-2022-327007 CrossrefMedlineGoogle Scholar10. Hollenbach M, Decker A, Schmidt A, et al. A comparison between traumatic and atraumatic over-the-scope-clips in patients with duodenal ulcer bleeding: a retrospective analysis with propensity-score-based matching. Gastrointest Endosc. 2023. [PMID: 36738794] doi:10.1016/j.gie.2023.01.051 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Alan N. Barkun, MD, MSc; Ali A. Alali, MBBCh, BAO, MScAffiliations: Division of Gastroenterology, McGill University and the McGill University Health Centre, Montreal, Quebec, CanadaDepartment of Medicine, Faculty of Medicine, Kuwait University, Jabriyah, KuwaitDisclosures: Authors have reported no disclosures of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M23-0449.Corresponding Author: Alan N. Barkun, MD, MSc, Division of Gastroenterology, McGill University Health Centre, Room D7-346, 1650 Cedar Avenue, Montreal, QC H3G 1A4, Canada; e-mail, Alan.Barkun.[email protected]gouv.qc.ca.This article was published at Annals.org on 7 March 2023. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoComparison of Over-the-Scope Clips to Standard Endoscopic Treatment as the Initial Treatment in Patients With Bleeding From a Nonvariceal Upper Gastrointestinal Cause James Y.W. Lau , Rui Li , Chen-huan Tan , Xiu-jing Sun , Hao-jun Song , Lan Li , Feng Ji , Bu-jiang Wang , Dong-tao Shi , Wai K. Leung , Imogen Hartley , Alan Moss , Karina Y.Y. Yu , Bing Y. Suen , Peng Li , and Francis K.L. Chan Metrics Current IssueApril 2023Volume 176, Issue 4Page: 576-577KeywordsClinical trialsEsophagogastroduodenoscopyHemostatics ePublished: 7 March 2023 Issue Published: April 2023 Copyright & PermissionsCopyright © 2023 by American College of Physicians. 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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.022 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.003 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.004 | 0.004 |
| Open science | 0.002 | 0.000 |
| Research integrity | 0.006 | 0.008 |
| Insufficient payload (model declined to judge) | 0.009 | 0.004 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".