Over-the-scope clip as first-line treatment of peptic ulcer bleeding: is it suitable for all?

In this issue of Endoscopy, Soriani et al. [1] evaluate the efficacy of over-the-scope (OTS) clips versus through-the-scope (TTS) clips as a primary treatment in Forrest Ia–IIb peptic ulcer bleeding. They conducted a multicenter, randomized controlled trial (RCT) in four Italian and one Spanish center. This was the first trial to provide head-to-head comparison between two mechanical modalities in endoscopic hemostatic treatment for high risk peptic ulcer bleeding. The negative result of the 30-day rebleeding rate after successful initial hemostasis was 1.6% (1/61) and 3.9% (2/51) for patients treated with OTS clips and TTS clips, respectively (RR = 0.42, 95%CI 0.04–4.53; P=0.47). However, the successful initial hemostasis and overall clinical success rates were higher in the OTS clip group than in the TTS clip group (98.4% vs. 78.4%, P=0.001; 96.7% vs. 74.5%, P=0.001, respectively) with an absolute risk reduction of 20%.