P1524 - Evaluation of Efficacy of Mechanical versus Thermal Therapy Hemostasis in Non-Variceal Upper Gastrointestinal Bleed Patients on Dual Antiplatelet Therapy

Rahul Karna, MD, Bandhul Hans, MD, Dhruv Chaudhary, MD, Manish Dhawan, MD
Allegheny Health Network, Pittsburgh, PA

Introduction: Current endoscopic management of patients with non-variceal upper gastrointestinal bleeding (NVUGIB) who are on dual antiplatelet therapy (DAPT) is based upon institutional availability and user experience. There is no clear data available on efficacy of hemostatic clips with epinephrine as compared to bipolar cautery with epinephrine, the two commonly used hemostatic methods in patients with NVUGIB.

Methods: A retrospective chart review was done for all consecutive adult patients between 2015-2020 who presented with NVUGIB on DAPT (aspirin, clopidogrel; aspirin, ticagrelor; aspirin, prasugrel) to Allegheny Health Network and underwent endoscopy. Patients who had DAPT discontinued prior to EGD as per ASGE guidelines were excluded from the study. Patients undergoing hemostatic clips (mechanical therapy) with epinephrine or bipolar cautery (thermal therapy) with epinephrine were included for final analysis. Primary outcome was achievement of primary hemostasis while secondary outcomes were need for 2^nd hemostatic procedure, early rebleeding (within 7 days) and delayed rebleeding (within 30 days), length of stay and adverse events. Continuous normally distributed variables were reported as means and standard deviation. Categorical variables were expressed as counts and percentages. The Mann-Whitney U test and Fisher’s exact test were used for group comparisons. P-value < 0.05 was considered as level of significance.

Results: Out of 203 patients presenting with NVUGIB on DAPT, 26 patients were included for the final analysis. Mean age was 71.4±11.8 years; range, 54 – 99 years; 20/26 (76.9%) patients were male. None of the comparisons were found to be statistically significant between patients in the two groups, however there was trend towards increased risk of rebleeding and need for reintervention in thermal therapy group. (Table 1)

Discussion: Although there was no statistical difference between the two hemostasis modalities, there was a trend towards increased need for 2^nd hemostatic procedure and incidence of early rebleeding in thermal therapy group. These are the preliminary results of the study comparing efficacy of two methods on patients at high risk of bleeding from DAPT or DOAC. The study needs to be replicated in larger patient population to evaluate the efficacy of two methods, which would have real world practical significance.

Variable	Hemostatic clips with Epinephrine (n = 12)	Bipolar cautery with Epinephrine (n = 14)	p-Value
Primary (initial) hemostasis, n (%)			1.0
Yes	11 (91.7)	12 (85.7)
No	1 (8.3)	2 (14.3)
Need for 2nd hemostasis procedure, n (%)			1.0
Yes	1 (8.3)	2 (14.3)
Procedure(s) performed	Thermal (cautery) + Epinephrine	Both patients underwent Mechanical (clips) + Epinephrine
No	11 (91.7)	12 (85.7)
Re-bleeding, n (%)			1.0
Yes	3 (25)	4 (28.6)
No	9 (75)	10 (71.4)
Re-bleeding within 7 days, n (%)			.598
Yes	1 (8.3)	3 (21.4)
	Patient re-bled on day 3	3 patients re-bled on day 3
No	11 (91.7)	11 (78.6)
Re-bleeding within 30 days, n (%)			.652
Yes	2 (16.7)	4 (28.6)
	Includes patients that re-bled on day 3 and day 10	Includes patients that re-bled on days 3, 3, 3, and 16
No	10 (83.3)	10 (71.4)
Length of hospital stay (days)			.781
Median (Inter-quartile range)	5.5 (11)	6.0 (4.0)
Range	2 – 30	2 – 12
Adverse event from procedure, n (%)
Yes	0	0
No	12 (100)	14 (100)

Table: Evaluation of the efficacy of hemostatic clips with epinephrine as compared to bipolar cautery with epinephrine in patients on DAPT presenting with NVUGIB (n = 26)


Disclosures:
Rahul Karna indicated no relevant financial relationships.
Bandhul Hans indicated no relevant financial relationships.
Dhruv Chaudhary indicated no relevant financial relationships.
Manish Dhawan indicated no relevant financial relationships.


Rahul Karna, MD, Bandhul Hans, MD, Dhruv Chaudhary, MD, Manish Dhawan, MD. P1524 - Evaluation of Efficacy of Mechanical versus Thermal Therapy Hemostasis in Non-Variceal Upper Gastrointestinal Bleed Patients on Dual Antiplatelet Therapy, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.