Endoscopic therapy reduces rebleeding, the need for surgery, and mortality in patients with bleeding peptic ulcers.
Epinephrine injection is the most popular therapeutic method. However, guidelines disagree on the need for a second hemostatic procedure immediately after epinephrine.
In this study, researchers from Spain determined whether the addition of a second procedure improves hemostatic efficacy and/or patient outcomes after epinephrine injection.
The team performed a systematic review and meta-analysis.
|Bleeding decreased regardless of which second procedure was used.|
They searched for randomized trials comparing epinephrine alone versus epinephrine plus a second method.
The team identified 16 studies including 1673 patients that met their inclusion criteria.
The researchers found that adding a second procedure reduced the further bleeding rate from 18% to 11%. It also reduced the need for emergency surgery from 11% to 8%.
In addition, mortality fell from 5% to 3%.
The team determined that the risk of further bleeding decreased regardless of which second procedure was applied.
Dr Xavier Calvet's team concluded, "Additional endoscopic treatment after epinephrine injection reduces further bleeding, need for surgery, and mortality in patients with bleeding peptic ulcer".