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

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art_BARACAT_Endoscopic_hemostasis_for_peptic_ulcer_bleeding_systematic_review_2016.PDF (1.12 MB)
Citações na Scopus
40
Tipo de produção
article
Data de publicação
2016
Editora
SPRINGER
DOI
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Scopus
Web of Science
PubMed
Título da Revista
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Título do Volume
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Autor de Grupo de pesquisa
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Citação
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, v.30, n.6, p.2155-2168, 2016
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
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.
Palavras-chave
Non-variceal upper gastrointestinal bleeding, Gastrointestinal hemorrhage, Peptic ulcer, Endoscopy, Endoscopic hemostasis
URI
https://observatorio.fm.usp.br/handle/OPI/16406
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Coleções
Artigos e Materiais de Revistas Científicas - HC/ICHC
Artigos e Materiais de Revistas Científicas - LIM/35