Bleeding Peptic UlcerOTSC-LBGDUNCT06196710
The Use of OTSC in LBGDU to Standard Endoscopic Hemostatic Methods
A study testing Over-the-scope Clips and Hemo-clipping in people with Bleeding Peptic Ulcer, run by Chinese University of Hong Kong.
Trial summary
In managing bleeding gastroduodenal ulcers, endoscopic control of bleeding is the first line treatment-further bleeding after endoscopic hemostasis is associated with a 3-fold increase in mortality. Large ulcer size (> 20 mm) predicts further bleeding. Read more about this study
- Who is it for?
- Ages 18 to 111 years
- Conditions the study is for
- Bleeding Peptic Ulcer
- What is being tested?
- Over-the-scope Clips and Hemo-clipping
- Type of treatment
- Injection or infusion, Medical device
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 0 participants
- Where
- No sites listed yet
- Study dates
- 1 Oct 2025to 1 Dec 2027
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 111 years
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- patients admitted with acute upper gastrointestinal bleeding (melena, hematemesis, or decrease in hemoglobin level with or without hypotension).
- large gastro-duodenal ulcers (20 mm in size or more)
- active bleeding (pulsatile or Forrest Ia bleeding, oozing from a visible vessel, or Forrest Ib bleeding) or a nonbleeding visible vessel (Forrest IIa lesion). Clots overlying bleeding lesions are injected with diluted epinephrine and then irrigated or elevated using a cheese-wiring technique. If a vessel is then unveiled, we can proceed with randomization.
Who cannot join
- patients with esophagogastric varices
- pregnant or lactating women
- patients who cannot provide written consent
- moribund from their co-morbid illnesses and are not considered for active treatment.
About this study
Official title: The Use of Over-the-scope-clips in Large Bleeding Gastro-duodenal Ulcers; a Randomized Comparison to Standard Endoscopic Hemostatic Methods
In managing bleeding gastroduodenal ulcers, endoscopic control of bleeding is the first line treatment-further bleeding after endoscopic hemostasis is associated with a 3-fold increase in mortality. Large ulcer size (> 20 mm) predicts further bleeding. These ulcers erode into arteries of significant size (>2 mm) from either the gastro-duodenal or left gastric arterial complexes. An over-the-scope clip is an endoscopic clamp device with a high tensile strength. It can compress sizeable arteries, and firmly anchor onto the ulcer base avoiding recurrent bleeding from clip dislodgement. It therefore offers secure and durable hemostasis.
In the proposed randomized controlled trial, the investigators hypothesize that after initial endoscopic control of bleeding from large gastro-duodenal ulcers (20 mm in size or more), adding an OTSC can prevent recurrent bleeding and improve patients' outcomes. Investigators enroll patients with bleeding from large ulcers as defined. After initial endoscopic control of bleeding using injection with diluted epinephrine, these patients are randomized, during endoscopy, to receive standard treatment (thermo-coagulation or hemo-clips) or an added OTSC. The primary endpoint is recurrent bleeding over 30 days confirmed on endoscopy. Secondary endpoints include the need for rescue treatment; endoscopic, angiographic embolization or surgery, red blood cell (RBC) transfusion, hospitalization, and bleeding related and all-cause mortality.
Read the detailed description
Endoscopic hemostatic treatment is the cornerstone of the management of patients with acute nonvariceal upper gastrointestinal bleeding. The current standard in endoscopic hemostasis includes the use of hemo-clips or contact thermal devices with or without pre-injection with diluted epinephrine. However, the failure rate with either method approaches 10%. Further bleeding after endoscopic treatment is associated with a 3-fold increase in mortality. The United Kingdom audit reported a 30% mortality in those who required surgery after failed endoscopic treatment.
Over-the-scope clips (OTSCs) are memory-shaped nitinol clips that are cap-mounted onto the end of an endoscope. They were designed for endoscopic closure of full-thickness mucosal defects. They are being increasingly used for the purpose of hemostasis. When deployed, the OTSC provides firm compression on bleeding vessels of significant sizes (>2mm). The retention rate with OTSCs is high avoiding recurrent bleeding from clip dislodgement.
The OTSCs were first evaluated as a rescue treatment in the German Multicenter Trial (Stop the Bleeding or STING 1 trial). The trial enrolled patients with bleeding from their ulcers refractory to standard endoscopic treatment and randomized them to receive either OTSC or further treatment with standard methods. Further bleeding within 30 days after either treatment was 15.2% and 57.6% respectively.
The primary use of OTSC i.e. as the first hemostatic device has been studied in several trials. (see Table 1).
Table 1: Further bleeding in 30 days Author, Year OTSC Standard Treatment
Jensen 2021 1 /25, 4% 8/ 28, 28.6%
Meier 2022 4/ 44, 8.3% 14/ 52, 26.9%
Chan 2023 (ulcers 15 mm or more) 5/ 50, 10% 9/ 50, 18%
Lau 2023 3/ 93, 3.2% 14/ 97, 14.6%
All of the above studies except one showed significant differences in the rate of further bleeds within 30 days in favor of the use of OTSC.
The role of OTSCs in larger gastroduodenal ulcers remains inconclusive. Chan studied exclusively ulcers of 15 mm or above in size. In this study, the use of OTSC did not significantly reduce further bleeds compared to standard treatment (rate of further bleeding 10% vs. 18%). There may have been two reasons to explain a negative trial; first, there were 4 primary failures with the use of OTSC (4/ 50, 8%). Two OTSCs did not fully encompass the vessels. In 2 cases, there were persistent bleeds despite the placement of OTSCs. The authors attributed the failure with the use of OTSC to a learning curve issue. Recurrent bleeds occurred in 2 of 46 (4.4%) after OTSC and 9 of 48 (18.8%) after standard treatments. Because of a small sample size and likely a type 2 error, the overall difference did not reach statistical significance. Gastroduodenal ulcers of 20 mm or more in size are the most critical predictor of further bleeds and failures with endoscopic treatment. These ulcers erode into major arterial complexes to the gastroduodenal and left gastric arteries. An OTSC appears to work well in such ulcers. In a post hoc analysis of our randomized controlled trial (RCT) on the primary use of OTSCs, further bleeds among ulcers 20 mm or larger occurred in 1 of 10 after OTSC treatment compared to 5 of 9 after standard treatment. Because of the inconclusive and conflicting results from the above trials regarding the efficacy of OTSC in high-risk (20mm or larger in size) bleeding gastroduodenal ulcers, investigators propose a randomized controlled trial with the hypothesis that OTSC is superior to standard treatment in bleeding gastroduodenal ulcers 20mm or greater in size. Investigators argue that OTSC should be the primary treatment of choice for ulcers of such size.
Research methods Trial Design and Organisation This study is an investigator-initiated multicentre trial. The participating centers are tertiary referral university hospitals with a high case volume. These include the Prince of Wales Hospital, Hua-Xi Hospital of Szechuan University, Beijing Friendship Hospital, the first affiliated Hospital of Nanchang University, Nanfang Hospital from China, and the King Chulalongkorn Memorial Hospital in Thailand. These hospitals have substantial experience with the use of OTSC and participated in earlier and ongoing clinical trials that evaluate the use of OTSC.
Investigators will obtain approval from the institutional review board in each participating hospital.
The joint Chinese University of Hong Kong-New Territories East Cluster Clinical Research Ethics Committee oversees the trial execution. Senior physicians from the committee adjudicate outcomes and review serious adverse events.
- Conditions
- Bleeding Peptic Ulcer
- Being tested
- Over-the-scope Clips, Hemo-clipping
- Medical subject headings
- Peptic Ulcer Hemorrhage
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Over-the-scope ClipsDevice
Also called OTSC
Over-the-scope Clips is mounted onto a transparent cap, which is attached to the tip of the endoscope. To deploy the claw device, a cogwheel at the scope head is turned pulling a trip string. This in turn retracts the cap releasing the OTSC onto the vessels.
Hemo-clippingDevice
Also called quick clips, thermo-coagulation
Contact thermocoagulation using a 3.3mm probe, hemo-clips, or both. The use of the bipolar device involves firm mechanical compression and coagulation for about 8 seconds.
| Study group | Role | What they receive |
|---|---|---|
| Over-the-scope Clips | Experimental | Endoscopic Application of Over-the-scope Clips Receives: Device: Over-the-scope Clips |
| standard treatment | Active comparator | standard treatment of either hemo-clipping or thermo-coagulation with or without pre injection with diluted epinephrine <=20 clips or pulse Receives: Device: Hemo-clipping |
What is being measured
The primary outcome is the main question the study is designed to answer.
bleeding free probability in 30 days after randomization
further bleeding defined by the composite of failure to control bleeding after assigned endoscopic treatment and recurrent bleeding.
Measured: 30 days
Secondary outcomes (4)
failure to control bleeding with assigned endoscopic treatment and recurrent bleeding after initial hemostasis
failure to control bleeding during the first endoscopy was defined as persistent or active bleeding after the attempted application of assigned endoscopic treatment. Recurrent bleeding was defined by fresh hematemesis, fresh melena, or hematochezia with hemodynamic instability (systolic blood pressure <90 mm Hg, heart rate >110 beats/min), and/or decrease in hemoglobin level greater than 20 g/L in 24 hours after transfusion to around 80 g/L. Patients who fulfill the clinical criteria of recurrent bleeding undergo urgent endoscopy. Recurrent bleeding requires endoscopic confirmation showing fresh blood in the gastroduodenal tract and active bleeding from a previously treated ulcer.
Measured: 30 days
number of participants using angiographic treatment
angiogram with embolization to bleeding vessel if primary failure or rebleeding
Measured: 30 days
number of participants using surgical treatment
surgical treatment if primary failure or rebleeding
Measured: 30 days
second endoscopic attempts at hemostasis
attempts at hemostasis if primary failure or rebleeding.
Measured: 30 days
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted9 Jan 2024
- Study start1 Oct 2025 (estimated)
- Primary completion1 Jun 2027 (estimated)
- Study completion1 Dec 2027 (estimated)
Why it stopped: We were not funded for the project.
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (11)Papers the sponsor has linked to this study.
- Other trials for Bleeding Peptic UlcerStudies of the same condition, open and under way.
- More trials run by Chinese University of Hong KongThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- Patients are randomized in a 1:1 ratio to receive; endoscopic treatment using OTSC or standard therapies.
- Masking
- None (open label)
- Enrolment
- 0 participants (actual)
Sponsor and investigators
- Lead sponsor
- Chinese University of Hong Kong
- Sponsor type
- University, hospital or other
- Collaborators
- King Chulalongkorn Memorial Hospital, West China Hospital, Beijing Friendship Hospital, Nanfang Hospital, Southern Medical University, The First Affiliated Hospital of Nanchang University
- Responsible party
- Principal investigator, James Yun-wong Lau, MD, Chinese University of Hong Kong
- Investigators
- YUN WONG LAU, Principal investigator, Chinese University of Hong Kong
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT06196710
- Sponsor's protocol ID
- OTSC-LBGDU
- Acronym
- OTSC-LBGDU
- Status last verified
- Jan 2025
- First submitted
- 26 Dec 2023
- Last updated
- 24 Jan 2025
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Barkun AN, Almadi M, Kuipers EJ, Laine L, Sung J, Tse F, Leontiadis GI, Abraham NS, Calvet X, Chan FKL, Douketis J, Enns R, Gralnek IM, Jairath V, Jensen D, Lau J, Lip GYH, Loffroy R, Maluf-Filho F, Meltzer AC, Reddy N, Saltzman JR, Marshall JK, Bardou M. Management of Nonvariceal Upper Gastrointestinal Bleeding: Guideline Recommendations From the International Consensus Group. Ann Intern Med. 2019 Dec 3;171(11):805-822. doi: 10.7326/M19-1795. Epub 2019 Oct 22.
PubMed 31634917Hearnshaw SA, Logan RF, Lowe D, Travis SP, Murphy MF, Palmer KR. Acute upper gastrointestinal bleeding in the UK: patient characteristics, diagnoses and outcomes in the 2007 UK audit. Gut. 2011 Oct;60(10):1327-35. doi: 10.1136/gut.2010.228437. Epub 2011 Apr 13.
PubMed 21490373Schmidt A, Golder S, Goetz M, Meining A, Lau J, von Delius S, Escher M, Hoffmann A, Wiest R, Messmann H, Kratt T, Walter B, Bettinger D, Caca K. Over-the-Scope Clips Are More Effective Than Standard Endoscopic Therapy for Patients With Recurrent Bleeding of Peptic Ulcers. Gastroenterology. 2018 Sep;155(3):674-686.e6. doi: 10.1053/j.gastro.2018.05.037. Epub 2018 May 24.
PubMed 29803838Jensen DM, Kovacs T, Ghassemi KA, Kaneshiro M, Gornbein J. Randomized Controlled Trial of Over-the-Scope Clip as Initial Treatment of Severe Nonvariceal Upper Gastrointestinal Bleeding. Clin Gastroenterol Hepatol. 2021 Nov;19(11):2315-2323.e2. doi: 10.1016/j.cgh.2020.08.046. Epub 2020 Aug 20.
PubMed 32828873Meier B, Wannhoff A, Denzer U, Stathopoulos P, Schumacher B, Albers D, Hoffmeister A, Feisthammel J, Walter B, Meining A, Wedi E, Zachaus M, Pickartz T, Kullmer A, Schmidt A, Caca K. Over-the-scope-clips versus standard treatment in high-risk patients with acute non-variceal upper gastrointestinal bleeding: a randomised controlled trial (STING-2). Gut. 2022 Jul;71(7):1251-1258. doi: 10.1136/gutjnl-2021-325300. Epub 2022 Mar 23.
PubMed 35321938Lau JYW, Li R, Tan CH, Sun XJ, Song HJ, Li L, Ji F, Wang BJ, Shi DT, Leung WK, Hartley I, Moss A, Yu KYY, Suen BY, Li P, Chan FKL. Comparison of Over-the-Scope Clips to Standard Endoscopic Treatment as the Initial Treatment in Patients With Bleeding From a Nonvariceal Upper Gastrointestinal Cause : A Randomized Controlled Trial. Ann Intern Med. 2023 Apr;176(4):455-462. doi: 10.7326/M22-1783. Epub 2023 Mar 7.
PubMed 36877964Chan S, Pittayanon R, Wang HP, Chen JH, Teoh AY, Kuo YT, Tang RS, Yip HC, Ng SKK, Wong S, Mak JWY, Chan H, Lau L, Lui RN, Wong M, Rerknimitr R, Ng EK, Chiu PWY. Use of over-the-scope clip (OTSC) versus standard therapy for the prevention of rebleeding in large peptic ulcers (size >/=1.5 cm): an open-labelled, multicentre international randomised controlled trial. Gut. 2023 Apr;72(4):638-643. doi: 10.1136/gutjnl-2022-327007. Epub 2022 Oct 28.
PubMed 36307177Elmunzer BJ, Young SD, Inadomi JM, Schoenfeld P, Laine L. Systematic review of the predictors of recurrent hemorrhage after endoscopic hemostatic therapy for bleeding peptic ulcers. Am J Gastroenterol. 2008 Oct;103(10):2625-32; quiz 2633. doi: 10.1111/j.1572-0241.2008.02070.x. Epub 2008 Aug 5.
PubMed 18684171Vergara M, Bennett C, Calvet X, Gisbert JP. Epinephrine injection versus epinephrine injection and a second endoscopic method in high-risk bleeding ulcers. Cochrane Database Syst Rev. 2014 Oct 13;2014(10):CD005584. doi: 10.1002/14651858.CD005584.pub3.
PubMed 25308912Lau JYW, Pittayanon R, Wong KT, Pinjaroen N, Chiu PWY, Rerknimitr R, Holster IL, Kuipers EJ, Wu KC, Au KWL, Chan FKL, Sung JJY. Prophylactic angiographic embolisation after endoscopic control of bleeding to high-risk peptic ulcers: a randomised controlled trial. Gut. 2019 May;68(5):796-803. doi: 10.1136/gutjnl-2018-316074. Epub 2018 May 25.
PubMed 29802172Casagrande JT, Pike MC. An improved approximate formula for calculating sample sizes for comparing two binomial distributions. Biometrics. 1978 Sep;34(3):483-6. No abstract available.
PubMed 719125
Study at a glance
From the registry record, last updated by the sponsor on 24 Jan 2025. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- The Use of Over-the-scope-clips in Large Bleeding Gastro-duodenal Ulcers; a Randomized Comparison to Standard Endoscopic Hemostatic Methods
- ClinicalTrials.gov ID
- NCT06196710
- Acronym / sponsor ID
- OTSC-LBGDU / OTSC-LBGDU
- Conditions
- Bleeding Peptic Ulcer
- Study type
- Interventional
- Recruitment status
- WithdrawnReason stopped: We were not funded for the project.
- Enrolment
- 0 participants (actual)
- Lead sponsor
- Chinese University of Hong KongUniversity, hospital or other
- Collaborators
- King Chulalongkorn Memorial Hospital, West China Hospital, Beijing Friendship Hospital, Nanfang Hospital, Southern Medical University, The First Affiliated Hospital of Nanchang University
- Study start
- 1 Oct 2025 (estimated)
- Primary completion
- 1 Jun 2027 (estimated)
- Study completion
- 1 Dec 2027 (estimated)
- First posted
- 9 Jan 2024 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
In managing bleeding gastroduodenal ulcers, endoscopic control of bleeding is the first line treatment-further bleeding after endoscopic hemostasis is associated with a 3-fold increase in mortality. Large ulcer size (> 20 mm) predicts further bleeding. These ulcers erode into arteries of significant size (>2 mm) from either the gastro-duodenal or left gastric arterial complexes. An over-the-scope clip is an endoscopic clamp device with a high tensile strength. It can compress sizeable arteries, and firmly anchor onto the ulcer base avoiding recurrent bleeding from clip dislodgement. It therefore offers secure and durable hemostasis.
In the proposed randomized controlled trial, the investigators hypothesize that after initial endoscopic control of bleeding from large gastro-duodenal ulcers (20 mm in size or more), adding an OTSC can prevent recurrent bleeding and improve patients' outcomes. Investigators enroll patients with bleeding from large ulcers as defined. After initial endoscopic control of bleeding using injection with diluted epinephrine, these patients are randomized, during endoscopy, to receive standard treatment (thermo-coagulation or hemo-clips) or an added OTSC. The primary endpoint is recurrent bleeding over 30 days confirmed on endoscopy. Secondary endpoints include the need for rescue treatment; endoscopic, angiographic embolization or surgery, red blood cell (RBC) transfusion, hospitalization, and bleeding related and all-cause mortality.
Detailed description
Endoscopic hemostatic treatment is the cornerstone of the management of patients with acute nonvariceal upper gastrointestinal bleeding. The current standard in endoscopic hemostasis includes the use of hemo-clips or contact thermal devices with or without pre-injection with diluted epinephrine. However, the failure rate with either method approaches 10%. Further bleeding after endoscopic treatment is associated with a 3-fold increase in mortality. The United Kingdom audit reported a 30% mortality in those who required surgery after failed endoscopic treatment.
Over-the-scope clips (OTSCs) are memory-shaped nitinol clips that are cap-mounted onto the end of an endoscope. They were designed for endoscopic closure of full-thickness mucosal defects. They are being increasingly used for the purpose of hemostasis. When deployed, the OTSC provides firm compression on bleeding vessels of significant sizes (>2mm). The retention rate with OTSCs is high avoiding recurrent bleeding from clip dislodgement.
The OTSCs were first evaluated as a rescue treatment in the German Multicenter Trial (Stop the Bleeding or STING 1 trial). The trial enrolled patients with bleeding from their ulcers refractory to standard endoscopic treatment and randomized them to receive either OTSC or further treatment with standard methods. Further bleeding within 30 days after either treatment was 15.2% and 57.6% respectively.
The primary use of OTSC i.e. as the first hemostatic device has been studied in several trials. (see Table 1).
Table 1: Further bleeding in 30 days Author, Year OTSC Standard Treatment
Jensen 2021 1 /25, 4% 8/ 28, 28.6%
Meier 2022 4/ 44, 8.3% 14/ 52, 26.9%
Chan 2023 (ulcers 15 mm or more) 5/ 50, 10% 9/ 50, 18%
Lau 2023 3/ 93, 3.2% 14/ 97, 14.6%
All of the above studies except one showed significant differences in the rate of further bleeds within 30 days in favor of the use of OTSC.
The role of OTSCs in larger gastroduodenal ulcers remains inconclusive. Chan studied exclusively ulcers of 15 mm or above in size. In this study, the use of OTSC did not significantly reduce further bleeds compared to standard treatment (rate of further bleeding 10% vs. 18%). There may have been two reasons to explain a negative trial; first, there were 4 primary failures with the use of OTSC (4/ 50, 8%). Two OTSCs did not fully encompass the vessels. In 2 cases, there were persistent bleeds despite the placement of OTSCs. The authors attributed the failure with the use of OTSC to a learning curve issue. Recurrent bleeds occurred in 2 of 46 (4.4%) after OTSC and 9 of 48 (18.8%) after standard treatments. Because of a small sample size and likely a type 2 error, the overall difference did not reach statistical significance. Gastroduodenal ulcers of 20 mm or more in size are the most critical predictor of further bleeds and failures with endoscopic treatment. These ulcers erode into major arterial complexes to the gastroduodenal and left gastric arteries. An OTSC appears to work well in such ulcers. In a post hoc analysis of our randomized controlled trial (RCT) on the primary use of OTSCs, further bleeds among ulcers 20 mm or larger occurred in 1 of 10 after OTSC treatment compared to 5 of 9 after standard treatment. Because of the inconclusive and conflicting results from the above trials regarding the efficacy of OTSC in high-risk (20mm or larger in size) bleeding gastroduodenal ulcers, investigators propose a randomized controlled trial with the hypothesis that OTSC is superior to standard treatment in bleeding gastroduodenal ulcers 20mm or greater in size. Investigators argue that OTSC should be the primary treatment of choice for ulcers of such size.
Research methods Trial Design and Organisation This study is an investigator-initiated multicentre trial. The participating centers are tertiary referral university hospitals with a high case volume. These include the Prince of Wales Hospital, Hua-Xi Hospital of Szechuan University, Beijing Friendship Hospital, the first affiliated Hospital of Nanchang University, Nanfang Hospital from China, and the King Chulalongkorn Memorial Hospital in Thailand. These hospitals have substantial experience with the use of OTSC and participated in earlier and ongoing clinical trials that evaluate the use of OTSC.
Investigators will obtain approval from the institutional review board in each participating hospital.
The joint Chinese University of Hong Kong-New Territories East Cluster Clinical Research Ethics Committee oversees the trial execution. Senior physicians from the committee adjudicate outcomes and review serious adverse events.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
- Model description
- Patients are randomized in a 1:1 ratio to receive; endoscopic treatment using OTSC or standard therapies.
| Arm | Type | Receives |
|---|---|---|
| Over-the-scope Clips | Experimental | Device: Over-the-scope ClipsEndoscopic Application of Over-the-scope Clips |
| standard treatment | Active comparator | Device: Hemo-clippingstandard treatment of either hemo-clipping or thermo-coagulation with or without pre injection with diluted epinephrine <=20 clips or pulse |
Who may qualify
- Ages
- 18 to 111 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (3 listed)
- patients admitted with acute upper gastrointestinal bleeding (melena, hematemesis, or decrease in hemoglobin level with or without hypotension).
- large gastro-duodenal ulcers (20 mm in size or more)
- active bleeding (pulsatile or Forrest Ia bleeding, oozing from a visible vessel, or Forrest Ib bleeding) or a nonbleeding visible vessel (Forrest IIa lesion). Clots overlying bleeding lesions are injected with diluted epinephrine and then irrigated or elevated using a cheese-wiring technique. If a vessel is then unveiled, we can proceed with randomization.
Key exclusion criteria (4 listed)
- patients with esophagogastric varices
- pregnant or lactating women
- patients who cannot provide written consent
- moribund from their co-morbid illnesses and are not considered for active treatment.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Over-the-scope ClipsAlso: OTSCOver-the-scope Clips is mounted onto a transparent cap, which is attached to the tip of the endoscope. To deploy the claw device, a cogwheel at the scope head is turned pulling a trip string. This in turn retracts the cap releasing the OTSC onto the vessels. | Device | Over-the-scope Clips |
| Hemo-clippingAlso: quick clips, thermo-coagulationContact thermocoagulation using a 3.3mm probe, hemo-clips, or both. The use of the bipolar device involves firm mechanical compression and coagulation for about 8 seconds. | Device | standard treatment |
Primary outcome
bleeding free probability in 30 days after randomization
Time frame: 30 days
further bleeding defined by the composite of failure to control bleeding after assigned endoscopic treatment and recurrent bleeding.
4 secondary outcomes
failure to control bleeding with assigned endoscopic treatment and recurrent bleeding after initial hemostasis
Time frame: 30 days
number of participants using angiographic treatment
Time frame: 30 days
number of participants using surgical treatment
Time frame: 30 days
second endoscopic attempts at hemostasis
Time frame: 30 days
Results and safety
The study was withdrawn before enrolling participants, so there are no results.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 24 Jan 2025.
- Results publication: PubMed 31634917Barkun AN, Almadi M, Kuipers EJ, Laine L, Sung J, Tse F, Leontiadis GI, Abraham NS, Calvet X, Chan FKL, Douketis J, Enns R, Gralnek IM, Jairath V, Jensen D, Lau J, Lip GYH, Loffroy R, Maluf-Filho F, Meltzer AC, Reddy N, Saltzman JR, Marshall JK, Bardou M. Management of Nonvariceal Upper Gastrointestinal Bleeding: Guideline Recommendations From the International Consensus Group. Ann Intern Med. 2019 Dec 3;171(11):805-822. doi: 10.7326/M19-1795. Epub 2019 Oct 22.
- Results publication: PubMed 21490373Hearnshaw SA, Logan RF, Lowe D, Travis SP, Murphy MF, Palmer KR. Acute upper gastrointestinal bleeding in the UK: patient characteristics, diagnoses and outcomes in the 2007 UK audit. Gut. 2011 Oct;60(10):1327-35. doi: 10.1136/gut.2010.228437. Epub 2011 Apr 13.
- Results publication: PubMed 29803838Schmidt A, Golder S, Goetz M, Meining A, Lau J, von Delius S, Escher M, Hoffmann A, Wiest R, Messmann H, Kratt T, Walter B, Bettinger D, Caca K. Over-the-Scope Clips Are More Effective Than Standard Endoscopic Therapy for Patients With Recurrent Bleeding of Peptic Ulcers. Gastroenterology. 2018 Sep;155(3):674-686.e6. doi: 10.1053/j.gastro.2018.05.037. Epub 2018 May 24.
- Results publication: PubMed 32828873Jensen DM, Kovacs T, Ghassemi KA, Kaneshiro M, Gornbein J. Randomized Controlled Trial of Over-the-Scope Clip as Initial Treatment of Severe Nonvariceal Upper Gastrointestinal Bleeding. Clin Gastroenterol Hepatol. 2021 Nov;19(11):2315-2323.e2. doi: 10.1016/j.cgh.2020.08.046. Epub 2020 Aug 20.
- Results publication: PubMed 35321938Meier B, Wannhoff A, Denzer U, Stathopoulos P, Schumacher B, Albers D, Hoffmeister A, Feisthammel J, Walter B, Meining A, Wedi E, Zachaus M, Pickartz T, Kullmer A, Schmidt A, Caca K. Over-the-scope-clips versus standard treatment in high-risk patients with acute non-variceal upper gastrointestinal bleeding: a randomised controlled trial (STING-2). Gut. 2022 Jul;71(7):1251-1258. doi: 10.1136/gutjnl-2021-325300. Epub 2022 Mar 23.
- Results publication: PubMed 36877964Lau JYW, Li R, Tan CH, Sun XJ, Song HJ, Li L, Ji F, Wang BJ, Shi DT, Leung WK, Hartley I, Moss A, Yu KYY, Suen BY, Li P, Chan FKL. Comparison of Over-the-Scope Clips to Standard Endoscopic Treatment as the Initial Treatment in Patients With Bleeding From a Nonvariceal Upper Gastrointestinal Cause : A Randomized Controlled Trial. Ann Intern Med. 2023 Apr;176(4):455-462. doi: 10.7326/M22-1783. Epub 2023 Mar 7.
- Results publication: PubMed 36307177Chan S, Pittayanon R, Wang HP, Chen JH, Teoh AY, Kuo YT, Tang RS, Yip HC, Ng SKK, Wong S, Mak JWY, Chan H, Lau L, Lui RN, Wong M, Rerknimitr R, Ng EK, Chiu PWY. Use of over-the-scope clip (OTSC) versus standard therapy for the prevention of rebleeding in large peptic ulcers (size >/=1.5 cm): an open-labelled, multicentre international randomised controlled trial. Gut. 2023 Apr;72(4):638-643. doi: 10.1136/gutjnl-2022-327007. Epub 2022 Oct 28.
- Results publication: PubMed 18684171Elmunzer BJ, Young SD, Inadomi JM, Schoenfeld P, Laine L. Systematic review of the predictors of recurrent hemorrhage after endoscopic hemostatic therapy for bleeding peptic ulcers. Am J Gastroenterol. 2008 Oct;103(10):2625-32; quiz 2633. doi: 10.1111/j.1572-0241.2008.02070.x. Epub 2008 Aug 5.
- Results publication: PubMed 25308912Vergara M, Bennett C, Calvet X, Gisbert JP. Epinephrine injection versus epinephrine injection and a second endoscopic method in high-risk bleeding ulcers. Cochrane Database Syst Rev. 2014 Oct 13;2014(10):CD005584. doi: 10.1002/14651858.CD005584.pub3.
- Results publication: PubMed 29802172Lau JYW, Pittayanon R, Wong KT, Pinjaroen N, Chiu PWY, Rerknimitr R, Holster IL, Kuipers EJ, Wu KC, Au KWL, Chan FKL, Sung JJY. Prophylactic angiographic embolisation after endoscopic control of bleeding to high-risk peptic ulcers: a randomised controlled trial. Gut. 2019 May;68(5):796-803. doi: 10.1136/gutjnl-2018-316074. Epub 2018 May 25.
- Results publication: PubMed 719125Casagrande JT, Pike MC. An improved approximate formula for calculating sample sizes for comparing two binomial distributions. Biometrics. 1978 Sep;34(3):483-6. No abstract available.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
YUN WONG LAU principal investigator
Chinese University of Hong Kong
Questions about this trial
What is this clinical trial studying?
A study testing Over-the-scope Clips and Hemo-clipping in people with Bleeding Peptic Ulcer, run by Chinese University of Hong Kong.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 3 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: withdrawn, as of the sponsor's last update on 24 Jan 2025. Status can change between updates, so confirm with the study contact before making plans.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study was withdrawn before enrolling participants, so there are no results.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
bleeding free probability in 30 days after randomization (time frame: 30 days). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT06196710, which also lists 11 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 24 Jan 2025.