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Introduction Several randomized controlled trials (RCTs) have compared over the scope clips (OTSC) with standard endoscopic treatments for first line treatment of non-variceal upper gastrointestinal bleeding (NVUGIB) and have reported promising result. We conducted a meta-analysis of RCTs to compare the efficacy of OTSC with standard treatments as the first line endoscopic treatment of NVUGIB.Methods We reviewed several databases to identify RCTs that compared OTSC with standard endoscopic treatments as the first-line treatment of NVUGIB. Our outcomes of interest were re-bleeding, initial hemostasis, angiographic embolization, surgery, mortality, length of stay, and mean number of units of blood transfused. We calculated pooled risk ratios (RR) with 95% confidence intervals (CI) for the analysis of categorical variables and mean differences (MD) with 95% CI for the analysis of continuous variables. Data were analyzed using a random effect model. Heterogeneity was assessed by I 2 statistics.Results We included five RCTs with 555 patients. Rate of rebleeding was significantly lower in OTSC group, RR (95% CI): 0.39 (0.21, 0.73). There was no significant difference in rate of Initial hemostasis between groups, RR (95% CI): 1.08 (0.98, 1.18). We found no significant difference in other outcomes between groups including need for angiographic embolization, surgery, mortality, length of stay and mean number of units of blood transfused.Conclusions Our meta-analysis demonstrates superiority of OTSC over standard endoscopic treatments in decreasing the risk of rebleeding in patients with NVUGIB when used as the firstline endoscopic treatment.Abstract P311 Figure 1Pooled risk ratios comparing OTSC and standard therapy