The Clinical Application Of Over-the-Scope Clip In The Treatment Of Acute Nonvariceal Upper Gastrointestinal Bleeding

Objective:To compare the difference between new endoscopic hemostasis with over-the-scope clip(OTSC)and conventional endoscopic hemostasis with through-the-scope clip(TTSC)for peptic ulcer bleeding and Dieulafoy lesion bleeding.Objective to investigate the clinical effect of OTSC in the treatment of acute non variceal upper gastrointestinal bleeding.Methods:1.Using the method of retrospective study,22 cases of peptic ulcer bleeding patients treated by endoscopic hemostasis with over-the-scope clip and 24 cases recently completed by endoscopic hemostasis with through-the-scope clip before the application of endoscopic hemostasis with over-the-scope clip as the research object,to evaluate the efficacy and safety of endoscopic hemostasis with over-the-scope clip by comparing immediate hemostasis success(rate),the total number of clips used for operation,first successful hemostasis(rate),postoperative recurrence(rate),successful hemostasis(rate),rebleeding(rate),two endoscopic treatment(rate),permanent hemostasis(rate),complications(rate),postoperative hospital stay time(d),death(rate).2.Using the method of retrospective study,14 cases of Dieulafoy lesion bleeding patients treated by endoscopic hemostasis with over-the-scope clip and 14 cases recently completed by endoscopic hemostasis with through-the-scope clip before the application of endoscopic hemostasis with over-the-scope clip as the research object,to evaluate the efficacy and safety of endoscopic hemostasis with over-the-scope clip by comparing immediate hemostasis success(rate),the total number of clips used for operation,first successful hemostasis(rate),postoperative recurrence(rate),successful hemostasis(rate),rebleeding(rate),two endoscopic treatment(rate),permanent hemostasis(rate),complications(rate),postoperative hospital stay time(d),death(rate).Results:1.Immediate hemostasis success(rate)of peptic ulcer bleeding patients treated with endoscopic hemostasis with OTSC was 20/22(90.9%)and the total number of clips used for operation was 22,the first successful hemostasis(rate)was 20/22(90.9%),postoperative recurrence(rate)was 1/20(5%),successful hemostasis(rate)was19/22(86.4%),rebleeding(rate)was 1/20(5%),two endoscopic treatment(rate)was 3/22(13.6%),permanent hemostasis(rate)was 18/22(81.8%),complications(rate)was 0/22(0%),postoperative hospital stay time(d)was(8.950 + 0.9638)d,death(rate)was 0/22(0%).Immediate hemostasis success(rate)of peptic ulcer bleeding patients treated with endoscopic hemostasis with TTSC was 13/24(54.2%)and the total number of clips used for operation was 56,the first successful hemostasis(rate)was 13/24(54.2%),postoperative recurrence(rate)was 0/13(0%),successful hemostasis(rate)was 13/24(54.2%),rebleeding(rate)was 0/13(0%),two endoscopic treatment(rate)was 11/24(45.8%),permanent hemostasis(rate)was 13/24(54.2%),complications(rate)was 0/24(0%),hospitalization time after operation(d)was(8.538 + 0.5264)d,death(rate)was 1/24(4.2%).2.Immediate hemostasis success(rate)of Dieulafoy lesion bleeding patients treated with endoscopic hemostasis with OTSC was 14/14(100%)and the total number of clips used for operation was 14,the first successful hemostasis(rate)was 14/14(100%),postoperative recurrence(rate)was 1/14(7.1%),successful hemostasis(rate)was 13/14(92.9%),rebleeding(rate)was 1/14(7.1%),two endoscopic treatment(rate)was 1/14(7.1%),permanent hemostasis(rate)was 13/14(92.9%),complications(rate)was 0/14(0%),postoperative hospital stay time(d)was(9.500±1.308)d,death(rate)was 0/14(0%).Immediate hemostasis success(rate)of Dieulafoy lesion bleeding patients treated with endoscopic hemostasis therapy with TTSC was 12/14(85.7%)and the total number of clips used for operation was 28,the first successful hemostasis(rate)was 10/14(71.4%),postoperative recurrence(rate)was 4/12(33.3%),successful hemostasis(rate)was 8/14(57.1%),rebleeding(rate)was 1/11(9.1%),two endoscopic treatment(rate)was 5/14(35.7%),permanent hemostasis(rate)was 8/14(57.1%),complications(rate)was 0/14(0%),hospitalization time after operation(d)was(10.00±1.314)d,death(rate)was 1/14(7.2%).Conclusion;Endoscopic hemostasis with over-the-scope clip is safe and effective in the treatment of acute nonvariceal upper gastrointestinal bleeding.Endoscopic hemostasis with over-the-scope clip can be used as the first choice for the treatment of complicated and refractory acute nonvariceal upper gastrointestinal bleeding due to rupture of blood vessel with the larger diameter or other causes.