Table 3.
Subgroup analysis comparing outcomes of over-the-scope clip therapy vs conventional therapy across different bleeding etiologies
|
Subgroup
|
Outcome
|
Pooled RR (OTSC/CT)
|
95%CI
|
P value
|
| Peptic ulcer | 30-day rebleeding | 0.404 | 0.292-0.559 | 0.0001 |
| Short-term rebleeding | 0.434 | 0.286-0.66 | 0.0001 | |
| Initial hemostasis | 1.016 | 0.998-1.034 | 0.0774 | |
| Surgical/TAE necessity | 1.122 | 0.603-2.087 | 0.7171 | |
| 30-day mortality | 0.844 | 0.506-1.406 | 0.5138 | |
| Bleeding mortality | 0.741 | 0.14-3.922 | 0.7241 | |
| Tumor | 30-day rebleeding | 0.581 | 0.322-1.05 | 0.0719 |
| Short-term rebleeding | 0.47 | 0.237-0.934 | 0.0312 | |
| Initial hemostasis | 1.04 | 0.987-1.095 | 0.1447 | |
| Surgical/TAE necessity | 0.697 | 0.228-2.13 | 0.5263 | |
| 30-day mortality | 0.361 | 0.173-0.753 | 0.0066 | |
| Bleeding mortality | 0.163 | 0.019-1.383 | 0.0964 | |
| Other | 30-day rebleeding | 0.5 | 0.315-0.792 | 0.0032 |
| Short-term rebleeding | 0.635 | 0.336-1.201 | 0.1628 | |
| Initial hemostasis | 1.033 | 0.966-1.105 | 0.34 | |
| Surgical/TAE necessity | 2.154 | 0.833-5.57 | 0.1136 | |
| 30-day mortality | 1.147 | 0.568-2.314 | 0.7021 | |
| Bleeding mortality | 1.0 | 0.02-49.913 | 1.0 |
Pooled risk ratios with 95%CI and P values are presented for each outcome, stratified by etiology: Peptic ulcer, tumor, and other causes. In peptic ulcer bleeding, Over-the-scope clips (OTSC) significantly reduced both 30-day and short-term rebleeding rates, with no significant difference in initial hemostasis, need for surgical or transarterial embolization, or mortality outcomes. In tumor-related bleeding, OTSC was associated with a significant reduction in short-term rebleeding and 30-day mortality, while other outcomes showed no statistically significant differences. In bleeding from other causes, OTSC significantly reduced 30-day rebleeding but did not significantly affect other outcomes. OTSC: Over-the-scope clips; CT: Computed tomography; RR: Relative risk; TAE: Transarterial embolization.