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20.10.2015 | Review | Ausgabe 6/2016

Surgical Endoscopy 6/2016

Endoscopic hemostasis for peptic ulcer bleeding: systematic review and meta-analyses of randomized controlled trials

Zeitschrift:
Surgical Endoscopy > Ausgabe 6/2016
Autoren:
Felipe Baracat, Eduardo Moura, Wanderley Bernardo, Leonardo Zorron Pu, Ernesto Mendonça, Diogo Moura, Renato Baracat, Edson Ide
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1007/​s00464-015-4542-x) contains supplementary material, which is available to authorized users.

Abstract

Background

Peptic ulcer represents the most common cause of upper gastrointestinal bleeding. Endoscopic therapy can reduce the risks of rebleeding, continued bleeding, need for surgery, and mortality. The objective of this review is to compare the different modalities of endoscopic therapy.

Methods

Studies were identified by searching electronic databases MEDLINE, Embase, Cochrane, LILACS, DARE, and CINAHL. We selected randomized clinical trials that assessed contemporary endoscopic hemostatic techniques. The outcomes evaluated were: initial hemostasis, rebleeding rate, need for surgery, and mortality. The possibility of publication bias was evaluated by funnel plots. An additional analysis was made, including only the higher-quality trials.

Results

Twenty-eight trials involving 2988 patients were evaluated. Injection therapy alone was inferior to injection therapy with hemoclip and with thermal coagulation when evaluating rebleeding and the need for emergency surgery. Hemoclip was superior to injection therapy in terms of rebleeding; there were no statistically significant differences between hemoclip alone and hemoclip with injection therapy. There was considerable heterogeneity in the comparisons between hemoclip and thermal coagulation. There were no statistically significant differences between thermal coagulation and injection therapy, though their combination was superior, in terms of rebleeding, to thermal coagulation alone.

Conclusions

Injection therapy should not be used alone. Hemoclip is superior to injection therapy, and combining hemoclip with an injectate does not improve hemostatic efficacy above hemoclip alone. Thermal coagulation has similar efficacy as injection therapy; combining these appears to be superior to thermal coagulation alone. Therefore, we recommend the application of hemoclips or the combined use of injection therapy with thermal coagulation for the treatment of peptic ulcer bleeding.

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Zusatzmaterial
Supplementary material 1 (ZIP 1224 kb)
464_2015_4542_MOESM1_ESM.zip
Literatur
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