Non-variceal gastrointestinal hemorrhage (NVGIH) remains a common and potentially life-threatening emergency associated with substantial morbidity and mortality. Endoscopic intervention is the cornerstone of management, with conventional modalities—including pharmacological, thermal and/or mechanical approaches such as through-the-scope (TTS) clips or band ligation—achieving high rates of initial hemostasis. However, rebleeding can occurs in up to 26% of patients with high-risk stigmata. The atraumatic over-the-scope clip (aOTSC) system represents a newer endoscopic device capable of full-thickness tissue approximation and durable mechanical compression. Growing evidence suggests that aOTSC provides superior hemostatic efficacy as both rescue or primary therapy in selected high-risk patients, with lower rebleeding and mortality rates.

Prospective study of total of patients treated with 11/6 aOTSC® (Ovesco Endoscopy AG, Germany) as a primary or rescue therapy for gastrointestinal bleeding at a tertiary health care center in Portugal, since device acquisition (2023). Efficacy and safety rates were evaluated.

Seven cases of gastrointestinal bleeding were managed with aOTSC (57.1% (n=4) male sex and mean age of 82.0±7.7 years-old). Mean Charlson Comorbidity Index was 5.6±2.2. About eighty-eight percent (n=6) of patients presented with upper gastrointestinal bleeding. Only two patients (28.6%) were on antithrombotic medication. On admission, the mean hemoglobin was 5.9±1.3g/dL, systolic blood pressure 106.7±40.5mmHg, and heart rate 86.2±11.5bpm. Endoscopy revealed two Dieulafoy lesions (one gastric, one duodenal), four gastric ulcers (Forrest Ib and IIa), and one sigmoid diverticular bleeding. Five (71.4%) patients initially received conventional hemostatic therapy—on average 2.0±0.8 attempts—including argon plasma coagulation, epinephrine injection, and TTS clips. The mean Rockall score after the first endoscopy was 7.1±2.2, indicating high rebleeding risk. Mean calibre of bleeding vessel was 3.0±0.7mm in diameter. Two (28.6%) patients were readmitted for rebleeding before aOTSC placement. First-line use of aOTSC reduced the number of hospitalization days (9.00±1.00 vs 11.00±3.74days; p=0.558), as well as the number of procedures required (0 vs 2.0±0.84procedures; p=0.047). Immediate hemostasis was achieved in all cases. No rebleeding for a medium follow-up of 6.6±6.5months. No complications or mortality were observed.

aOTSC proved to be effective and safe as hemostatic endoscopic therapy for both primary and rescue gastrointestinal bleeding due to the high transmural grip force without tissue trauma, particularly to the blood vessel walls. All patients presented with high-risk features, such as high post-endoscopic Rockall score and bleeding vessel >2mm in diameter. This highlights the further need to establish standardized criteria and clinical scoring systems for the early or first-line aOTSC use.