S1402 Over-the-Scope Clips Halve 30-Day Clinical Failure Without Extra Rescue Therapy in High-Risk Peptic-Ulcer Bleeding: A Contemporary Systematic Review and Meta-Analysis of Randomized Controlled Trials

Introduction: Over-the-scope clips (OTSC) offer a promising solution for achieving single-device, suture-strength closure in challenging non-variceal upper gastrointestinal bleeding cases. However, the widespread application of OTSC has surpassed the availability of high-level evidence to support its efficacy. Prior reviews have focused solely on technical success and initial hemostasis. This study addresses this critical gap in the literature, as OTSC has already been included in various international treatment protocols. We present the first meta-analysis limited to randomized trials, specifically designed to evaluate guideline-relevant, patient-centered outcomes. Methods: A systematic search of PubMed, Embase, Scopus, and Cochrane Library identified Randomized Controlled Trials (RCTs) comparing over the scope clips with conventional through-the-scope clips ± adjuvant therapy through May 2025. Data were analyzed using RevMan 4.2.1. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using Mantel-Haenszel methods. Random- or fixed-effects models were applied based on heterogeneity (Higgins’ I²). Statistical significance was set at P < 0.05. Risk of bias was assessed using RoB 2.0. Results: OTSC reduced clinical failure by 59% (13/184 vs 33/181; RR 0.41, 95% CI 0.22–0.75; P = 0.004) 11% absolute risk reduction and number-needed-to-treat of 9. Rates of rescue therapy were similar (14/184 vs 12/181; RR 1.07, 0.52–2.20), refuting concerns that upfront OTSC merely postpones escalation. Thirty-day mortality was low but numerically favoured OTSC (6/159 vs 12/153; RR 0.49, 0.19–1.27). All trials achieved 100% technical deployment with no clip-related perforations. Conclusion: This meta-analysis using only RCTs delivers the first precise, patient-centred estimate of OTSC benefit i.e. a halving of clinical failure without extra downstream procedures and a possible survival advantage. Uniform endpoints and zero heterogeneity make the data guideline-ready. Sparing one in 9 patients from re-bleeding translates into fewer transfusions, ICU stays and bed-day costs that leads to tangible gains for resource-stretched endoscopy units. These data provide a rationale for OTSC to be considered as a first-line option and should inform future guideline updates.