The optimal management of bleeding peptic ulcer with adherent clot is controversial and may include endoscopic therapy or medical therapy.
Dr Charles Kahi and colleagues searched MEDLINE, BIOSIS, EMBASE, and the Cochrane Library and conducted a meta-analysis.
The researchers identified all randomized controlled trials comparing the 2 interventions.
Outcomes evaluated were recurrent bleeding, need for surgical intervention, length of hospitalization, transfusion requirement, and mortality.
The research team identified 6 studies that included 240 patients from the United States, Hong Kong, South Korea, and Spain.
Patients in the endoscopic therapy group underwent endoscopic clot removal and treatment of the underlying lesion.
|Rebleeding occurred in 8% with endoscopic therapy vs 25% with medical therapy|
The researchers reported that the underlying lesion was treated with thermal energy, electrocoagulation, and/or injection of sclerosants.
The team observed that rebleeding occurred in 8% of patients in the endoscopic therapy group vs 25% in the medical therapy group with a relative risk of 0.4.
No difference between endoscopic therapy and medical therapy in length of hospital stay was noted.
There was also no difference between the 2 therapies in transfusion requirement, or mortality.
The team found that patients in the endoscopic therapy group were less likely to undergo surgery.
However, the researchers showed that this outcome became nonsignificant when only peer-reviewed studies were considered.
Dr Kahi's team concluded, “Endoscopic therapy is superior to medical therapy for preventing recurrent hemorrhage in patients with bleeding peptic ulcers and adherent clots.”
“The interventions are comparable with respect to the need for surgical intervention, length of hospital stay, transfusion requirement, and mortality.”