Over-the-scope clips versus standard endoscopic therapy as first-line treatment for bleeding peptic ulcer disease: a...

Peptic ulcer bleeding remains a significant cause of non-variceal upper gastrointestinal bleeding (NVUGIB). While over-the-scope clips (OTSC) are increasingly used as rescue therapy, their efficacy as first-line treatment remains unclear. The aim of this study is to evaluate the efficacy and safety of OTSC compared to standard endoscopic therapy (SET) as a first-line treatment in patients with bleeding peptic ulcer disease (PUD).

A systematic literature search was conducted across MEDLINE, Embase, Scopus, and Web of Science databases up to March 13, 2026. Studies comparing OTSC and SET in bleeding PUD were included. Primary outcome was Clinical Success. Secondary outcomes included primary and technical success, need for surgery or re-therapy, mortality, hospital stay, and adverse events. Meta-analyses were performed using a random-effects model.

Six studies [3 randomized controlled trials (RCTs), 3 observational] comprising 454 patients were included. OTSC significantly improved clinical success [risk ratio (RR) =1.16, 95% confidence interval (CI): 1.06-1.27, P=0.002]. OTSC also significantly reduced overall bleeding (RR =0.46, 95% CI: 0.25-0.82, P=0.009). No statistically significant differences were observed in primary success, technical success, 7- or 30-day rebleeding, need for re-therapy, surgical intervention, in-hospital mortality, total mortality, adverse events, or hospital stay.

OTSC is associated with significantly higher clinical success and lower overall bleeding rates compared to SET in bleeding PUD. Secondary outcomes, including rebleeding, re-intervention, and mortality, trended in favour of OTSC but did not reach statistical significance, likely reflecting limited power. These findings support OTSC as a promising first-line option. Further large-scale RCTs are warranted to confirm these results and guide clinical implementation.