339 WHY OVER-THE-SCOPE-CLIP IS POTENTIALLY MORE EFFECTIVE THAN STANDARD ENDOSCOPIC HEMOSTASIS AS PRIMARY TREATMENT OF SEVERE NON-VARICEAL UPPER GASTROINTESTINAL BLEEDING

Recurrent non-variceal upper gastrointestinal bleeding (NVUGIB) after standard visually guided endoscopic hemostasis is common in high-risk patients. In a recent randomized controlled trial (RCT), the 30-day rebleeding rate was 26.3% (20/76) with visually applied MPEC and/or standard hemoclips with or without epinephrine (Gastro 2017; 152: 1310 – 18). The rebleeding rate was reduced to 11.1% (8/72) when blood flow was monitored with Doppler endoscopic probe (DEP) and used as a guide for hemostasis. However, when residual arterial blood flow was not obliterated, the rebleeding rate was very high – 88.8% (8/9 patients). Our aims in this study of patients with severe NVUGIB were to 1) assess how effective over-the-scope-clip (OTSC) was in obliterating underlying arterial blood flow, 2) to compare results with standard endoscopic hemostasis, and 3) to determine whether OTSC as primary treatment of severe NVUGIB reduced rebleeding rates.