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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 …
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.
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