S676 Outcomes in Non-Variceal Upper Gastrointestinal Bleeding with Use of the Endoscopic Over-the-Scope-Clip Device Deployed by General Gastroenterologists and Trainees: Experience from a Large Academic Medical Center

Introduction: Non-variceal upper gastrointestinal bleeding (NVUGIB) is a common cause of hospitalization and is associated with an up to 30% incidence of rebleeding. Data increasingly suggests the over-the-scope clip (OTSC) is an effective and safe tool in hemostasis specifically for rebleeding, severe hemorrhage or large ulcers not amenable to standard therapy. Nevertheless, this tool remains underutilized in general gastroenterology (GI) practice and training. We seek to show our outcomes in hemostasis for NVUGIB after competency training of general GI attendings and trainees by our GI hospitalist. Methods: We performed a retrospective chart review of patients with NVUGIB who received treatment with OTSC by general GI faculty and trainees at a large quaternary care academic center between July 2019 and May 2022. Procedures were supervised by 6 attendings. Demographics are shown in Table. The primary outcome was 30-day rebleeding at the site of initial hemostasis, defined as clinical signs of bleeding with need for repeat endoscopic intervention or angiography. Results: We identified 52 patients hospitalized for NVUGIB who underwent upper endoscopy with use of the OTSC by general GI attendings and trainees. Of these cases, we observed a 30-day rebleeding rate of 13.5% (n = 7). We observed that patients who rebled had higher readmission rates (71.4% vs 13.3%, p < 0.05). No significant differences were observed in demographics, medical history, presenting labs, ulcer features, or length of stay between the two cohorts (Table). We observed that a majority of lesions were found within the duodenum (69.2%, n = 36), and a majority of these ulcers were large >10mm in size (82.7%, n = 43) in both groups. Of patients undergoing OTSC use for primary hemostasis versus secondary hemostasis, rebleeding rate was 15.6% (n = 5) and 10% (n = 2), respectively. Of patients who rebled, 3 underwent repeat endoscopy alone, and 2 underwent EGD & angiography, and 2 underwent angiography alone. No patients required surgery. There were no complications from OTSC placement. Conclusion: The OTSC is a highly effective tool in the management of NVUGIB specifically in cases of rebleeding, severe hemorrhage, and large ulcers not amenable to standard treatment. The OTSC can be safely and successfully deployed by general gastroenterologists and trainees. Education and competency in OTSC should be encouraged in physicians who treat NVUGIB. Table 1. - Characteristics of 52 patients with use of the OSTC for hemostasis by general GI attendings and trainees Patients N=52 HemostasisN=45 (86.5%) RebleedN=7 (13.5%) P-value Age, mean (years) 72.4 70.4 79 NS Gender NS Female 18 (34.6%) 17 (37.8%) 1 (14.3%) Male 34 (65.4%) 28 (62.2%) 6 (85.7%) Race NS White 28 (53.9%) 25 (55.6%) 3 (42.9%) Black 8 (15.4%) 7 (15.6%) 1 (14.3%) Asian 9 (17.3%) 8 (17.8%) 1 (14.3%) Hispanic 6 (11.5%) 4 (8.9%) 2 (28.6%) Other 1 (1.9%) 1 (2.2%) 0 Medical History Hypertension 34 (65.4%) 29 (64.4%) 5 (71.4%) NS CKD any stage 19 (36.5%) 15 (33.3%) 4 (57.1%) NS Diabetes 12 (23.1%) 10 (22.2%) 2 (28.6%) NS ASA Class NS ASA 1 1 (1.9%) 1 (2.2%) 0 ASA 2 7 (13.5%) 7 (15.6%) 0 ASA 3 24 (46.2%) 20 (44.4%) 4 (54.1%) ASA 4 20 (38.5%) 17 (37.8%) 3 (42.9%) Labs (Mean Values) Admission Hemoglobin (g/dL) 9.3 9.4 9.1 NS Hemoglobin Nadir (g/dL) 6.6 6.7 6.1 NS Platelets 256 259 237 NS INR 1.3 1.3 1.4 NS Medications Anticoagulation use prior to admission 16 (30.8%) 13 (28.9%) 3 (42.9%) NS Antiplatelet use prior to admission 27 (51.9%) 24 (53.3%) 3 (42.9%) NS PPI use prior to admission 9 (17.3%) 9 (20.0%) 0 NS PPI use following EGD in hospital 52 (100%) 45 (100%) 7 (100%) NS Ulcer Location NS Stomach 13 (25.0%) 13 (28.9%) 0 Duodenum 36 (69.2%) 29 (64.4%) 7 (100%) GJ anastomosis 2 (3.9%) 2 (4.4%) 0 GE junction 1 (1.9%) 1 (2.2%) 0 Large Ulcer >10 mm 43 (82.7%) 37 (82.2%) 6 (85.7%) NS Indication for Index EGD NS Primary Hemostasis 32 (61.5%) 27 (60.0%) 5 (71.4%) Secondary Hemostasis/Rebleeding 20 (38.5%) 18 (40.0%) 2 (28.6%) Adjuvant Endoscopic Treatment Epinephrine Injection 32 (61.5%) 27 (60.0%) 5 (71.4%) NS Endoscopic Doppler Probe 19 (36.5%) 17 (37.8%) 2 (28.6%) NS Forrest Classification of Ulcer NS Forrest Ia 0 (0%) 0 0 Forrest Ib 16 (30.7%) 12 (26.7%) 4 (57.1%) Forrest IIa 25 (48.1%) 22 (48.9%) 3 (42.9%) Forrest IIb 8 (15.4%) 8 (17.8%) 0 Forrest IIc 1 (1.9%) 1 (2.2%) 0 Forrest III 2 (3.9%) 2. (4.4%) 0 Outcomes Readmission within 30 days of index EGD 11 (21.2%) 6 (13.3%) 5 (71.4%) p< 0.05 Mean length of stay (days) 15.4 14.4 21.7 NS