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Over-the-scope clips versus standard treatment
  1. Alan N Barkun1,
  2. Loren Laine2,
  3. Grigorios I Leontiadis3,
  4. John R Saltzman4
  1. 1Department of Medicine, Division of Gastroenterology and the Department of Clinical Epidemiology, Biostatistics and Occupational Health, McGill University Health Centre, Montreal, Quebec, Canada
  2. 2Yale School of Medicine, New Haven, Connecticut, USA
  3. 3Division of Gastroenterology, McMaster University, Hamilton, Ontario, Canada
  4. 4Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Professor Alan N Barkun, McGill University Health Centre, Montreal, Quebec, Canada; alan.barkun{at}

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We read with interest the randomised controlled trial (RCT) addressing over-the-scope clips (OTSC) as a primary method of haemostasis in patients at high risk with non-variceal upper gastrointestinal bleeding (UGI).1 We commend the authors for having completed a well-conducted, difficult study. This study and some of its methodological aspects deserve examination in light of society guidelines suggesting OTSC should be reserved for patients who have failed initial traditional endoscopic therapy.2

One hundred patients with a complete Rockall score ≥7 were randomised to OTSC or standard treatment (through-the-scope clips (TTSC) and epinephrine injection in 98%). The primary endpoint of haemostasis without recurrent bleeding for 7 days was achieved in 91.7% with OTSC versus 73.1% with TTSC (p=0.019).

Two previous fully published randomised trials assessing OTSC in non-variceal UGI bleeding have suggested its superiority to standard approaches in managing recurrent bleeding,3 or as …

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  • Contributors All authors contributed to conception and design of the work, drafted and revising it for critically for important intellectual content and provided final approval of the version to be published.

  • 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 ANB, LL and GIL: none to report. JRS: receives royalties or licenses from uptodate and is a member, Board of Trustees for the American College of Gastroenterology.

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