There is no definite recommendation on the use of dual endoscopic therapy in patients with severe peptic ulcer bleeding.
Dr Riccardo Marmo and colleagues from Italy determined whether the use of 2 endoscopic hemostatic procedures improved patient outcomes compared with monotherapy.
The investigative team performed a systematic review and meta-analysis.
The team searched for randomized trials comparing dual endoscopic therapy versus monotherapy between 1990 and 2006.
Heterogeneity between studies was tested and explained by metaregression analysis.
|Endoscopic therapy reduced the risk of emergency surgery|
|American Journal of Gastroenterology|
The investigators recognized 20 studies with 2472 patients that met inclusion criteria.
Compared with controls, the team found that dual endoscopic therapy reduces the risk of recurrent bleeding.
Dual endoscopic therapy also reduced the risk of emergency surgery, and showed a trend toward a reduction in the risk of death.
The team used subcategory analysis to show that dual therapy was superior to injection therapy alone for all the outcomes considered.
The team noted that no combination of treatments was better than either mechanical therapy alone or thermal therapy alone.
Dr Marmo's team commented, “Dual endoscopic therapy proved significantly superior to epinephrine injection alone.”
“It had no advantage over thermal or mechanical monotherapy in improving the outcome of patients with high-risk peptic ulcer bleeding.”