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Endoscopic hemostasis for peptic ulcer bleeding: systematic review and meta-analyses of randomized controlled trials

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Abstract

Background

Peptic ulcer represents the most common cause of upper gastrointestinal bleeding. Endoscopic therapy can reduce the risks of rebleeding, continued bleeding, need for surgery, and mortality. The objective of this review is to compare the different modalities of endoscopic therapy.

Methods

Studies were identified by searching electronic databases MEDLINE, Embase, Cochrane, LILACS, DARE, and CINAHL. We selected randomized clinical trials that assessed contemporary endoscopic hemostatic techniques. The outcomes evaluated were: initial hemostasis, rebleeding rate, need for surgery, and mortality. The possibility of publication bias was evaluated by funnel plots. An additional analysis was made, including only the higher-quality trials.

Results

Twenty-eight trials involving 2988 patients were evaluated. Injection therapy alone was inferior to injection therapy with hemoclip and with thermal coagulation when evaluating rebleeding and the need for emergency surgery. Hemoclip was superior to injection therapy in terms of rebleeding; there were no statistically significant differences between hemoclip alone and hemoclip with injection therapy. There was considerable heterogeneity in the comparisons between hemoclip and thermal coagulation. There were no statistically significant differences between thermal coagulation and injection therapy, though their combination was superior, in terms of rebleeding, to thermal coagulation alone.

Conclusions

Injection therapy should not be used alone. Hemoclip is superior to injection therapy, and combining hemoclip with an injectate does not improve hemostatic efficacy above hemoclip alone. Thermal coagulation has similar efficacy as injection therapy; combining these appears to be superior to thermal coagulation alone. Therefore, we recommend the application of hemoclips or the combined use of injection therapy with thermal coagulation for the treatment of peptic ulcer bleeding.

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Authors and Affiliations

  1. Gastrointestinal Endoscopy Unit, Gastroenterology Department, University of Sao Paulo Medical School, Avenida Dr. Enéas de Carvalho Aguiar, 155, 6° andar, São Paulo, SP, CEP 05403-900, Brazil

    Felipe Baracat, Eduardo Moura, Leonardo Zorron Pu, Ernesto Mendonça, Diogo Moura, Renato Baracat & Edson Ide

  2. Thoracic Surgery Department, Instituto do Coraçao (InCor), University of Sao Paulo Medical School, São Paulo, Brazil

    Wanderley Bernardo

  3. Rua Martinico Prado, 241, apt 94, CEP 01224-010, São Paulo, SP, Brazil

    Felipe Baracat

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  1. Felipe Baracat
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Correspondence to Felipe Baracat.

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Drs Felipe Baracat, Eduardo Moura, Wanderley Bernardo, Leonardo Zorron Pu, Ernesto Mendonça, Diogo Moura, Renato Baracat, and Edson Ide have no conflicts of interest or financial ties to disclosure.

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Baracat, F., Moura, E., Bernardo, W. et al. Endoscopic hemostasis for peptic ulcer bleeding: systematic review and meta-analyses of randomized controlled trials. Surg Endosc 30, 2155–2168 (2016). https://doi.org/10.1007/s00464-015-4542-x

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