Drs Loren Laine and Kenneth McQuaid from the USA determined appropriate endoscopic treatment of patients with bleeding ulcers by synthesizing results of randomized controlled trials.
The team performed dual independent bibliographic database searches to identify randomized trials of thermal therapy or injection therapy.
Trials also identified clips for bleeding ulcers with active bleeding, visible vessels, or clots, focusing on results from studies without second-look endoscopy and re-treatment.
The primary end point was further bleeding.
Compared with epinephrine, further bleeding was reduced significantly by other monotherapies, with the number-needed-to-treat at 9.
The number-needed-to-treat for epinephrine followed by another modality was 5.
The team noted that epinephrine was not significantly less effective in studies with second-look and re-treatment.
|The number-needed-to-treat with sclerosant therapy was 5|
|Clinical Gastroenterology & Hepatology |
The researchers found that compared with no endoscopic therapy, further bleeding was reduced by thermal contact, with a number-needed-to-treat of 4.
The team noted that the number-needed-to-treat with sclerosant therapy was 5.
The research team observed that clips were more effective than epinephrine, but not different than other therapies.
However, the latter studies were heterogeneous, showing better and worse results for clips.
The team found that endoscopic therapy was effective for active bleeding, and a nonbleeding visible vessel, but not for a clot.
Bolus followed by continuous-infusion proton pump inhibitor after endoscopic therapy significantly improved outcome compared with placebo/no therapy, but not compared with histamine2-receptor antagonists.
The research team noted that thermal devices, sclerosants, clips, and thrombin/fibrin glue appear to be effective endoscopic hemostatic therapies.
Dr Loren Laine and coleague concluded, “Epinephrine should not be used alone.”
“Endoscopic therapy should be performed for ulcers with active bleeding and nonbleeding visible vessels, but efficacy is uncertain for clots.”
“Bolus followed by continuous-infusion intravenous proton pump inhibitor should be used after endoscopic therapy.”