State of the artEndoscopic Therapy for Bleeding Ulcers: An Evidence-Based Approach Based on Meta-Analyses of Randomized Controlled Trials
Section snippets
Methods
The study type we defined for inclusion was randomized controlled trials that compared one of the included interventions with no therapy or with a second included intervention. Studies with pseudorandomization (eg, day of the week, odd vs even patient number) were not included.
The population defined for inclusion was patients presenting with bleeding from a gastric or duodenal ulcer and found to have active bleeding, a nonbleeding visible vessel, or a clot at endoscopy. Because patients with
Results
The MEDLINE search produced 2044 citations and the Cochrane Central Registry search produced 1432 citations. A review of titles and abstracts led to 92 articles considered to be potentially relevant for full review. A review of the 92 full articles revealed 74 articles (75 studies) for inclusion.8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58,
Discussion
Meta-analyses dating back to the early l990s documented that endoscopic therapy overall was effective for patients with bleeding ulcers.91, 100 However, those analyses were driven by results from modalities that are not generally used at present (laser and monopolar electrocoagulation). Many more studies comparing endoscopic hemostatic therapies with no therapy or with one another have been published in the intervening years.
We sought to broadly address the major clinically relevant questions
Summary of Recommendations
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Epinephrine injection alone should not be used.
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Thermal therapy, sclerosant therapy, clips, and thrombin/fibrin glue all appear to be effective endoscopic hemostatic therapies.
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Epinephrine injection before these therapies may be beneficial, especially for the actively spurting ulcer, but data supporting such a benefit are extremely limited.
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Endoscopic therapy should be used for ulcers with active bleeding and nonbleeding visible vessels.
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The role of endoscopic therapy for ulcers with adherent clots
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Cited by (0)
The authors disclose the following: L.L. is a consultant for AstraZeneca, Novartis, Santarus, Eisai, and Merck and received research Support from TAP and GlaxoSmithKline. No support was received for this project.