Endoscopic therapy versus medical therapy for bleeding peptic ulcer with adherent clot

A meta-analysis

Charles Kahi, Dennis M. Jensen, Joseph J Y Sung, Brian L. Bleau, Kyung Jung Hye, George Eckert, Thomas Imperiale

Research output: Contribution to journalArticle

105 Citations (Scopus)

Abstract

Background & Aims: The optimal management of bleeding peptic ulcer with adherent clot is controversial and may include endoscopic therapy or medical therapy. Methods: We searched MEDLINE, BIOSIS, EMBASE, and the Cochrane Library to identify all randomized controlled trials comparing the 2 interventions. Outcomes evaluated in the meta-analysis were recurrent bleeding, need for surgical intervention, length of hospitalization, transfusion requirement, and mortality. Results: Six studies were identified 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 with thermal energy, electrocoagulation, and/or injection of sclerosants. Rebleeding occurred in 5 of 61 (8.2%) patients in the endoscopic therapy group, compared with 21 of 85 (24.7%) in the medical therapy group (P = .01), for a pooled relative risk of 0.35 (95% confidence interval, 0.14-0.83; number needed to treat, 6.3). There was no difference between endoscopic therapy and medical therapy in length of hospital stay (mean, 6.8 vs 5.6 days; P = .27), transfusion requirement (mean, 3.0 vs 2.8 units of packed red blood cells; P = .75), or mortality (9.8% vs 7%; P = .54). Patients in the endoscopic therapy group were less likely to undergo surgery (pooled relative risk, 0.43; 95% confidence interval, 0.19-0.98; number needed to treat, 13.3); however, this outcome became nonsignificant when only peer-reviewed studies were considered. Conclusions: 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.

Original languageEnglish
Pages (from-to)855-862
Number of pages8
JournalGastroenterology
Volume129
Issue number3
DOIs
StatePublished - Sep 2005

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Peptic Ulcer
Meta-Analysis
Hemorrhage
Group Psychotherapy
Length of Stay
Numbers Needed To Treat
Therapeutics
Mortality
Confidence Intervals
Sclerosing Solutions
Republic of Korea
Electrocoagulation
Hong Kong
MEDLINE
Spain
Libraries
Hospitalization
Randomized Controlled Trials
Hot Temperature
Erythrocytes

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Endoscopic therapy versus medical therapy for bleeding peptic ulcer with adherent clot : A meta-analysis. / Kahi, Charles; Jensen, Dennis M.; Sung, Joseph J Y; Bleau, Brian L.; Hye, Kyung Jung; Eckert, George; Imperiale, Thomas.

In: Gastroenterology, Vol. 129, No. 3, 09.2005, p. 855-862.

Research output: Contribution to journalArticle

Kahi, Charles ; Jensen, Dennis M. ; Sung, Joseph J Y ; Bleau, Brian L. ; Hye, Kyung Jung ; Eckert, George ; Imperiale, Thomas. / Endoscopic therapy versus medical therapy for bleeding peptic ulcer with adherent clot : A meta-analysis. In: Gastroenterology. 2005 ; Vol. 129, No. 3. pp. 855-862.
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abstract = "Background & Aims: The optimal management of bleeding peptic ulcer with adherent clot is controversial and may include endoscopic therapy or medical therapy. Methods: We searched MEDLINE, BIOSIS, EMBASE, and the Cochrane Library to identify all randomized controlled trials comparing the 2 interventions. Outcomes evaluated in the meta-analysis were recurrent bleeding, need for surgical intervention, length of hospitalization, transfusion requirement, and mortality. Results: Six studies were identified 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 with thermal energy, electrocoagulation, and/or injection of sclerosants. Rebleeding occurred in 5 of 61 (8.2{\%}) patients in the endoscopic therapy group, compared with 21 of 85 (24.7{\%}) in the medical therapy group (P = .01), for a pooled relative risk of 0.35 (95{\%} confidence interval, 0.14-0.83; number needed to treat, 6.3). There was no difference between endoscopic therapy and medical therapy in length of hospital stay (mean, 6.8 vs 5.6 days; P = .27), transfusion requirement (mean, 3.0 vs 2.8 units of packed red blood cells; P = .75), or mortality (9.8{\%} vs 7{\%}; P = .54). Patients in the endoscopic therapy group were less likely to undergo surgery (pooled relative risk, 0.43; 95{\%} confidence interval, 0.19-0.98; number needed to treat, 13.3); however, this outcome became nonsignificant when only peer-reviewed studies were considered. Conclusions: 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.",
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