Systematic review with network meta-analysis: dual therapy for high-risk bleeding peptic ulcersReportar como inadecuado

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BMC Gastroenterology

, 17:55

Gastroesophageal disorders


BackgroundAdding a second endoscopic therapy to epinephrine injection might improve hemostatic efficacy in patients with high-risk bleeding ulcers but the optimum modality remains unknown. We aimed to estimate the comparative efficacy of different dual endoscopic therapies for the management of bleeding peptic ulcers through random-effects Bayesian network meta-analysis.

MethodsDifferent databases were searched for controlled trials comparing dual therapy versus epinephrine monotherapy or epinephrine combined with another second modality until September, 30 2016. We estimated the ORs for rebleeding, surgery and mortality among different treatments. Adverse events were also evaluated.

ResultsSeventeen eligible articles were included in the network meta-analysis. The addition of mechanical therapy OR 0.19, 95% CrI 0.07–0.52 and OR 0.10, 95% CrI 0.01–0.50, respectively after epinephrine injection significantly reduced the probability of rebleeding and surgery. Similarly, patients who received epinephrine plus thermal therapy showed a significantly decreased rebleeding rate OR 0.30, 95% CrI 0.10–0.91, as well as a non-significant reduction in surgery OR 0.47, 95% CrI 0.16–1.20. Although differing, epinephrine plus mechanical therapy did not provide a significant reduction in rebleeding OR 0.62, 95% CrI 0.19–2.22 and surgery OR 0.21, 95% CrI 0.03–1.73 compared to epinephrine plus thermal therapy. Sclerosant failed to confer further benefits and was ranked highest among the 5 treatments in relation to adverse events.

ConclusionsMechanical therapy was the most appropriate modality to add to epinephrine injection. Epinephrine plus thermal coagulation was effective for controlling high risk bleeding ulcers. There was no further benefit with sclerosants with regard to rebleeding or surgery, and sclerosants were also associated with more adverse events than any other modality.

KeywordsUlcer bleeding Endoscopic hemostasis Mechanical therapy Thermal therapy Injection therapy AbbreviationsADDISAggregate Data Drug Information System

CrICredible interval

EpiEpinephrine injection

H2RAH2 receptor antagonist

HpHelicobacter pylori

MechMechanical hemostasis

NRNot reported

OROdds ration

PPIProton pump inhibitor

PRISMAPreferred Reporting Items for Systematic Reviews and Meta-Analyses

RCTsRandomized controlled trials

SclerSclerosant injection

ThermThermal coagulation

ThrombThrombin injection

Electronic supplementary materialThe online version of this article doi:10.1186-s12876-017-0610-0 contains supplementary material, which is available to authorized users.

Autor: Keda Shi - Zeren Shen - Guiqi Zhu - Fansheng Meng - Mengli Gu - Feng Ji


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