The role of endoscopic Doppler US in patients with peptic ulcer bleeding

Leerdam, Monique E. van; Rauws, E. A. J.; Geraedts, A. A. M.; Tijssen, Jan G.P.; Tytgat, G. N. J.

doi:10.1016/s0016-5107(03)02033-9

Cited by 31 publications

(30 citation statements)

References 26 publications

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“…Thus, the study may have failed to prove statistical significance (study p-value was 0.06) because of its limited sample size. Furthermore, an important difference in the van Leerdam et al study compared with prior studies showing superiority (statistical significance) of the use of DOP-US over Forrest classification-directed hemostasis was the use of high-dose intravenous proton-pump inhibitor in all patients (omeprazole 80 mg bolus intravenously followed by 8 mg/h continuous intravenous infusion for at least 24 h and usually longer) [24]. None of the prior published studies had used high-dose proton-pump inhibitors by continuous intravenous infusion because this practice was not recommended at that time.…”

Section: Discussionmentioning

confidence: 92%

“…van Leerdam et al [24] illustrated this problem. Their prospective, randomized, multicentered study was designed to examine the role of DOP-US in patients with acute peptic ulcer bleeding.…”

Section: Discussionmentioning

confidence: 99%

“…A recent meta-analysis by Bardou et al [26] showed that high-dose intravenous proton-pump inhibitors significantly reduced recurrent bleeding ( −14.6%), surgery ( −5.4%), and mortality ( −2.7%) when compared with placebo, and it reduced recurrent bleeding when compared with H2-receptor antagonist ( −20.6%) in acute peptic ulcer hemorrhage. Thus, because the van Leerdam et al study was significantly underpowered (40% of intended patient enrollment), a type II statistical error may have occurred [24].…”

Section: Discussionmentioning

confidence: 99%

“…Conversely, pigmented spots and ulcers with a clean base may demonstrate submucosal arterial flow. Importantly, independent studies have demonstrated that the presence of a positive Doppler signal immediately following endoscopic therapy predicts recurrent bleeding, which suggests that DOP-US may be useful for guiding ablative therapy [20,24].…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic Doppler Ultrasound Versus Endoscopic Stigmata-Directed Management of Acute Peptic Ulcer Hemorrhage: A Multimodel Cost Analysis

Chen

Wong

2006

Dig Dis Sci

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Recurrent bleeding from acute peptic ulcer hemorrhage is problematic. Studies have shown that Doppler ultrasound (DOP-US) is useful in decreasing rebleeding. We analyzed associated costs and outcomes to better define the role of DOP-US versus Conventional (Forrest classification endoscopic stigmata) in the management of acute peptic ulcer bleeding. Two separate decision analyses were constructed. Recurrent bleeding, failed esophagogastroduodenoscopy (EGD) hemostasis, complications, and surgery rates were derived from medical literature. Costs were based on Medicare data. DOP-US is preferred over Conventional in acute peptic ulcer bleeding with average cost savings per patient ranging from 853 dollars (decision-tree modeling) to 1,160 dollars (Monte Carlo simulation). High-dose intravenous proton-pump inhibitors lowered rates of recurrent bleeding for both Conventional and DOP-US, resulting in a lower but still persistent average cost savings per patient for DOP-US (decision-tree modeling = 328 dollars, Monte Carlo simulation = 560 dollars). This decision analyses identified DOP-US as the preferred cost-minimizing strategy in acute peptic ulcer hemorrhage. Results of cost analyses were most dependent on hospitalization costs and recurrent bleeding rates.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Endoscopic Doppler Ultrasound Versus Endoscopic Stigmata-Directed Management of Acute Peptic Ulcer Hemorrhage: A Multimodel Cost Analysis

Chen

Wong

2006

Dig Dis Sci

View full text Add to dashboard Cite

show abstract

“…Two published studies [2,3] have corresponding results showing that a positive Doppler signal immediately after injection treatment is associated with a significantly higher incidence of recurrent bleedings, which may be caused by inadequate initial endoscopic therapy. However, Doppler-negative lesions after endoscopic therapy rarely lead to rebleeding.…”

Section: Answer To Questionmentioning

confidence: 99%