title: First-line endoscopic treatment with over-the-scope clips significantly improves the primary failure and rebleeding rates in high-risk gastrointestinal bleeding: A single-center experience with 100 cases.
abstract: OBJECTIVE
  To evaluate rebleeding, primary failure (PF) and mortality of patients in whom over-the-scope clips (OTSCs) were used as first-line and second-line endoscopic treatment (FLET, SLET) of upper and lower gastrointestinal bleeding (UGIB, LGIB).
  
  
  METHODS
  A retrospective analysis of a prospectively collected database identified all patients with UGIB and LGIB in a tertiary endoscopic referral center of the University of Freiburg, Germany, from 04-2012 to 05-2016 (n= 93) who underwent FLET and SLET with OTSCs. The complete Rockall risk scores were calculated from patients with UGIB. The scores were categorized as < or ≥ 7 and were compared with the original Rockall data. Differences between FLET and SLET were calculated. Univariate and multivariate analysis were performed to evaluate the factors that influenced rebleeding after OTSC placement.
  
  
  RESULTS
  Primary hemostasis and clinical success of bleeding lesions (without rebleeding) was achieved in 88/100 (88%) and 78/100 (78%), respectively. PF was significantly lower when OTSCs were applied as FLET compared to SLET (4.9%vs23%,P= 0.008). In multivariate analysis, patients who had OTSC placement as SLET had a significantly higher rebleeding risk compared to those who had FLET (OR 5.3;P= 0.008). Patients with Rockall risk scores ≥ 7 had a significantly higher in-hospital mortality compared to those with scores < 7 (35%vs10%,P= 0.034). No significant differences were observed in patients with scores < or ≥ 7 in rebleeding and rebleeding-associated mortality.
  
  
  CONCLUSIONS
  Our data show for the first time that FLET with OTSC might be the best predictor to successfully prevent rebleeding of gastrointestinal bleeding compared to SLET. The type of treatment determines the success of primary hemostasis or primary failure.
authors.affiliation: Hans-Jürgen Richter-Schrag, Christine Walker, Andreas Fischer, Robert Thimme, Center of Interdisciplinary Gastrointestinal Endoscopy, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, D-79106 Freiburg, Germany.
authors.forename: Hans-Jürgen
authors.initials: HJ
authors.lastname: Richter-Schrag
authors.affiliation: Hans-Jürgen Richter-Schrag, Christine Walker, Andreas Fischer, Robert Thimme, Center of Interdisciplinary Gastrointestinal Endoscopy, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, D-79106 Freiburg, Germany.
authors.forename: Torben
authors.initials: T
authors.lastname: Glatz
authors.affiliation: Hans-Jürgen Richter-Schrag, Christine Walker, Andreas Fischer, Robert Thimme, Center of Interdisciplinary Gastrointestinal Endoscopy, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, D-79106 Freiburg, Germany.
authors.forename: Christine
authors.initials: C
authors.lastname: Walker
authors.affiliation: Hans-Jürgen Richter-Schrag, Christine Walker, Andreas Fischer, Robert Thimme, Center of Interdisciplinary Gastrointestinal Endoscopy, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, D-79106 Freiburg, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Fischer
authors.affiliation: Hans-Jürgen Richter-Schrag, Christine Walker, Andreas Fischer, Robert Thimme, Center of Interdisciplinary Gastrointestinal Endoscopy, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, D-79106 Freiburg, Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Thimme
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D016208:Databases, Factual; D020776:Endoscopes, Gastrointestinal; D004867:Equipment Design; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005858:Germany; D016558:Hemostasis, Endoscopic / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure; D055815:Young Adult
keywords: First-line endoscopic treatment; Gastrointestinal bleeding; Over-the-scope clip; Rockall risk score; Second-line endoscopic treatment