Hemoclips, injection therapy and thermocoagulation (heater probe or electrocoagulation) are the most commonly used types of endoscopic hemostasis for the control of non-variceal gastrointestinal (GI) bleeding.
Professor Joseph Sung and colleagues from Hong Kong compared the efficacy of hemoclips versus injection or thermocoagulation in endoscopic hemostasis by pooling data from the literature.
The team assessed publications in the English literature searching MEDLINE, EMBASE and the Cochrane Library.
| Definitive hemostasis occurred in 87% receiving hemoclips|
The team also searched abstracts in major international conferences using the keywords ‘hemoclips' and ‘bleeding'.
The team identified 15 trials fulfilling the search criteria.
Outcome measures included initial hemostasis after endoscopic intervention, and recurrent bleeding.
Definitive hemostasis defined as no recurrent bleeding until the end of follow-up, and the requirement for surgical intervention were measured.
In addition, the team recorded all-cause mortality.
The heterogeneity of trials was examined and the effects were pooled by meta-analysis.
The researcher reported that of 1156 patients recruited in the 15 studies, 390 were randomly assigned to receive clips alone.
The team noted that 242 received clips combined with injection, 359 received injection alone, and 165 received thermocoagulation with or without injection.
Definitive hemostasis occurred in 87% receiving hemoclips, and 75% receiving injection.
About 90% receiving endoscopic clips with injection, and 80% receiving injections alone had definitive hemostasis leading to a reduced requirement for surgery.
However, the team observed no difference in mortality.
When compared with thermocoagulation, the team found that there was no improvement in definitive hemostasis with clips.
These estimates were robust in sensitivity analyses.
The team noted no difference between clips and thermocoagulation in rebleeding, the need for surgery and mortality.
The reported locations of failed hemoclip applications included posterior wall of duodenal bulb, posterior wall of gastric body and lesser curve of the stomach.
Professor Sung's team concluded, "Successful application of hemoclips is superior to injection alone but comparable to thermocoagulation in producing definitive hemostasis."
"There was no difference in all-cause mortality irrespective of the modalities of endoscopic treatment."