Endoscopic clipping versus injection and thermo-coagulation in the treatment of non-variceal upper gastrointestinal bleeding: a meta-analysis

Sung, Joseph J.Y.; Tsoi, Kelvin K.F.; Lai, Lihui; Wu, Justin C.Y.; Lau, James Y.

doi:10.1136/gut.2007.123976

Cited by 255 publications

(159 citation statements)

References 27 publications

(26 reference statements)

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“…Sung et al in a meta-analysis of 15 studies reported that regardless of improvements in sustaining hemostasis by clipping leading to less re bleeding and fewer interventions with surgery, mortality has not been reduced and there is no indication of a reduction in the death rate [17]. Nevertheless, it is a mystery that despite successful control of hemorrhage in many studies using various combinations of endoscopic and pharmacological therapies the mortality rate remains unchanged.…”

Section: Discussionmentioning

confidence: 98%

Rokcall score versus forrest classification in endoscopic management of bleeding peptic ulcer

Assal¹,

Elsherbiny²,

Badawy³

et al. 2010

Health

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Acute upper gastrointestinal bleeding (UGIB) remains an important emergency situation. In the last two decades, major developments took place influencing incidence, etiology and outcome of patients with acute UGIB. Peptic ulcer bleeding is the most significant complication of ulcer disease being responsible for 50% of all cases mortality. Aim of the study: To compare between endoscopic clip application versus argon plasma coagulation in management of bleeding peptic ulcer (BPU). Patients and Methods: Sixty patients suffering from acute UGIB were randomly divided into two groups: group I included 30 patients treated with endoscopic clip application and Group II included 30 patients subjected to endoscopic APC. All patients were classified according to Forrest classification and the clinical Rockall score. Results: There were significant differences between the two groups as regard Forrest classification (P < 0.05) there were insignificant difference between the two groups as regard rockall score, site of the ulcer and re bleeding (P > 0.05). Re bleeding was significant with higher Rockall score in group I (P < 0.05) but it was insignificant in group II (P > 0.05). Conclusion: Endoscopic application of hemoclips have a less re bleeding rate than Argon plasma coagulation for treatment of bleeding peptic ulcer, although this was statistically insignificant, meanwhile APC is still less cost and easy. Clinical and endoscopic assessment (through Rokcall score and Forrest classification) could help in making best choice for endoscopic management.

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Section: Discussionmentioning

confidence: 98%

Rokcall score versus forrest classification in endoscopic management of bleeding peptic ulcer

Assal¹,

Elsherbiny²,

Badawy³

et al. 2010

Health

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“…In a meta-analysis performed by Sung et al (25), the pooled data from 15 studies indicated that endoscopic clipping, with or without injection, is more effective than endoscopic injection alone for the treatment of bleeding peptic ulcers, and at least as effective as thermal therapies for the induction of hemostasis and prevention of surgery and mortality.…”

Section: Discussionmentioning

confidence: 99%

Adrenaline Injection Plus Argon Plasma Coagulation versus Adrenaline Injection Plus Hemoclips for Treating High-Risk Bleeding Peptic Ulcers: A Prospective, Randomized Trial

Taghavi

Soleimani

Hosseini-Asl

et al. 2009

Canadian Journal of Gastroenterology

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BACKGROUND/OBJECTIVE: Several combination endoscopic therapies are currently in use. The present study aimed to compare argon plasma coagulation (APC) + adrenaline injection (AI) with hemoclips + AI for the treatment of high-risk bleeding peptic ulcers.METHODS: In a prospective randomized trial, 172 patients with major stigmata of peptic ulcer bleeding were randomly assigned to receive APC + AI (n=89) or hemoclips + AI (n=83). In the event of rebleeding, the initial modality was used again. Patients in whom treatment or retreatment was unsuccessful underwent emergency surgery. The primary end point of rebleeding rate and secondary end points of initial and definitive hemostasis need for surgery and mortality were compared between the two groups.RESULTS: The two groups were similar in all background variables. Definitive hemostasis was achieved in 85 of 89 (95.5%) of the APC + AI and 82 of 83 (98.8%) of the hemoclips + AI group (P=0.206). The mean volume of adrenaline injected in the two groups was equal (20.7 mL; P=0.996). There was no significant difference in terms of initial hemostasis (96.6% versus 98.8%; P=0.337), rate of rebleeding (11.2% versus 4.8%; P=0.124), need for surgery (4.5% versus 1.2%; P=0.266) and mortality (2.2% versus 1.2%; P=0.526). When compared for the combined end point of mortality plus rebleeding and the need for surgery, there was an advantage for the hemoclip group (6% versus 15.7%, P=0.042).CONCLUSION: Hemoclips + AI has no superiority over APC + AI in treating patients with high-risk bleeding peptic ulcers. Hemoclips + AI may be superior when a combination of all negative outcomes is considered.

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“…Endoscopic therapy is warranted for high-risk lesions that is, Forrest classification 1a, 1b, 2a, and 2b, 2b because of their greatest propensities for rebleeding if left untreated. Meta-analyses have confirmed that endoscopic hemostasis in this group of patients results in significant improvements in rebleeding, but have been underpowered to show any better improvement in the need for surgery or mortality [32,36,38,50]. Although all endoscopic techniques provide benefit, injection of epinephrine alone is superior to medical management alone, but is inferior to all other methods and should no longer be used as a sole endoscopic treatment when other methods are available.…”

Section: Endoscopic Therapeutic Modalitiesmentioning

confidence: 99%

The Acute Management of Nonvariceal Upper Gastrointestinal Bleeding

Dhahab

Barkun

2012

Ulcers

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Background. The mortality from nonvariceal upper gastrointestinal bleeding is still around 5%, despite the increased use of protonpump inhibitors and the advancement of endoscopic therapeutic modalities. Aim. To review the state-of-the-art management of acute non variceal upper gastrointestinal bleeding from the presentation to the emergency department, risk stratification, endoscopic hemostasis, and postendoscopic consolidation management to reduce the risk of recurrent bleeding from peptic ulcers. Methods. A PubMed search was performed using the following key words acute management, non variceal upper gastrointestinal bleeding, and bleeding peptic ulcers. Results. Risk stratifying patients with acute non variceal upper gastrointestinal bleeding allows the categorization into low risk versus high risk of rebleeding, subsequently safely discharging low risk patients early from the emergency department, while achieving adequate hemostasis in high-risk lesions followed by continuous proton-pump inhibitors for 72 hours. Dual endoscopic therapy still remains the recommended choice in controlling bleeding from peptic ulcers despite the emergence of new endoscopic modalities such as the hemostatic powder. Conclusion. The management of nonvariceal upper gastrointestinal bleeding involves adequate resuscitation, preendoscopic risk assessment, endoscopic hemostasis, and post endoscopic pharmacological and nonpharmacological treatment.

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Endoscopic clipping versus injection and thermo-coagulation in the treatment of non-variceal upper gastrointestinal bleeding: a meta-analysis

Cited by 255 publications

References 27 publications

Rokcall score versus forrest classification in endoscopic management of bleeding peptic ulcer

Rokcall score versus forrest classification in endoscopic management of bleeding peptic ulcer

Adrenaline Injection Plus Argon Plasma Coagulation versus Adrenaline Injection Plus Hemoclips for Treating High-Risk Bleeding Peptic Ulcers: A Prospective, Randomized Trial

The Acute Management of Nonvariceal Upper Gastrointestinal Bleeding

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