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Over-the-scope-clips versus standard treatment in high-risk patients with acute non-variceal upper gastrointestinal bleeding: a randomised controlled trial (STING-2)
  1. Benjamin Meier1,
  2. Andreas Wannhoff1,
  3. Ulrike Denzer2,
  4. Petros Stathopoulos2,
  5. Brigitte Schumacher3,
  6. David Albers3,
  7. Albrecht Hoffmeister4,
  8. Jürgen Feisthammel4,
  9. Benjamin Walter5,
  10. Alexander Meining5,6,
  11. Edris Wedi7,8,
  12. Markus Zachäus9,
  13. Tilman Pickartz10,
  14. Armin Küllmer11,
  15. Arthur Schmidt11,
  16. Karel Caca1
  1. 1 Gastroenterology, Klinikum Ludwigsburg, Ludwigsburg, Germany
  2. 2 Gastroenterology, University of Marburg, Marburg, Germany
  3. 3 Gastroenterology, Elisabeth-Krankenhaus-Essen, Essen, Germany
  4. 4 Gastroenterology, University of Leipzig, Leipzig, Germany
  5. 5 Gastroenterology, University of Ulm, Ulm, Germany
  6. 6 Gastroenterology, University of Würzburg, Würzburg, Germany
  7. 7 Gastroenterology, Sana Klinikum Offenbach, Offenbach, Germany
  8. 8 Gastroenterology, University of Göttingen, Göttingen, Germany
  9. 9 Gastroenterology, Helios Park-Klinikum Leipzig, Leipzig, Germany
  10. 10 Gastroenterology, University of Greifswald, Greifswald, Germany
  11. 11 Gastroenterology, University of Freiburg, Freiburg im Breisgau, Germany
  1. Correspondence to Professor Karel Caca, Gastroenterology, Klinikum Ludwigsburg, 71640 Ludwigsburg, Baden-Württemberg, Germany; karel.caca{at}


Objective Acute non-variceal upper gastrointestinal bleeding (NVUGIB) is managed by standard endoscopic combination therapy, but a few cases remain difficult and carry a high risk of persistent or recurrent bleeding. The aim of our study was to compare first-line over-the-scope-clips (OTSC) therapy with standard endoscopic treatment in these selected patients.

Design We conducted a prospective, randomised, controlled, multicentre study (NCT03331224). Patients with endoscopic evidence of acute NVUGIB and high risk of rebleeding (defined as complete Rockall Score ≥7) were included. Primary endpoint was clinical success defined as successful endoscopic haemostasis without evidence of recurrent bleeding.

Results 246 patients were screened and 100 patients were finally randomised (mean of 5 cases/centre and year; 70% male, 30% female, mean age 78 years; OTSC group n=48, standard group n=52). All but one case in the standard group were treated with conventional clips. Clinical success was 91.7% (n=44) in the OTSC group compared with 73.1% (n=38) in the ST group (p=0.019), with persistent bleeding occurring in 0 vs 6 in the OTSC versus standard group (p=0.027), all of the latter being successfully managed by rescue therapy with OTSC. Recurrent bleeding was observed in four patients (8.3%) in the OTSC group and in eight patients (15.4%) in the standard group (p=0.362).

Conclusion OTSC therapy appears to be superior to standard treatment with clips when used by trained physicians for selected cases of primary therapy of NVUGIB with high risk of rebleeding. Further studies are necessary with regards to patient selection to identify subgroups benefiting most from OTSC haemostasis.

Trial registration number NCT03331224.

  • endoscopy
  • bleeding

Data availability statement

All data relevant to this study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to this study are included in the article or uploaded as supplementary information.

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  • Contributors KC, AS and BM designed the study and wrote the protocol. BM was the coordinating physician at the study centre and wrote the manuscript according to CONSORT guidelines. AS and KC reviewed the manuscript extensively. All authors had access to the study data and reviewed and approved the final manuscript. Ovesco Endoscopy provided a financial allowance for participating centres and was involved in planning and designing the trial but did not participate in data collection, analysis or manuscript drafting. Guarantor of work: BM.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests BM received fees for research activities and lecture fees from Ovesco Endoscopy AG. AM is a consultant for Ovesco Endoscopy AG and received lecture fees from Ovesco Endoscopy AG. AS received lecture fees and study grants from Ovesco Endoscopy AG. EW and KC received lecture fees from Ovesco Endoscopy AG. AW, UD, PS, BS, DA, AH, JF, BMW, MZ, TP and AK have no disclosures to report.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.