Treatment Failure With Over-the-Scope Clip in High-Risk Gastrointestinal Bleeding: What Were the Causes?

We read with great interest the article by Brandler et al1 investigating the efficacy of over-the-scope clip (OTSC) as primary or rescue therapy for patients with bleeding lesions that are at high risk of adverse outcome (HR-AO). In this retrospective study, the authors identified 67 patients with gastrointestinal bleeding (Rockall score was 6.9 ± 1.4) arising from lesions that had HR-AO features and OTSC was successful in preventing rebleeding in 81.3% of cases. They defined HR-AO features as bleeding lesions (1) located in the territory of major arteries (duodenum, lesser curve, lower rectum); (2) presence of a large-caliber artery (>2 mm); (3) deep penetrating, excavated, and fibrotic ulcer with high-risk stigmata; and (4) high-risk of complications with standard endoscopic therapy.

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