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Endoscopic therapy outperforms conservative treatment for bleeding ulcers with adherent clots, in terms of reduced rebleeding, mortality, surgery, and shorter hospital stays.
A comprehensive systematic review and meta-analysis revealed that for the treatment of bleeding ulcers, endoscopic therapy is better than conservative therapy. Azizullah Beran et al. sought to make a comparison between endoscopic therapy and conservative approaches for the treatment of bleeding ulcers with adherent clots.
A systematic search was conducted in Web of Science, Embase, and PubMed databases to identify studies contrasting the treatment approaches for bleeding ulcers with adherent clots, specifically the endoscopic and conservative methods. The major endpoint of interest was the occurrence of rebleeding, both in the overall context and within a 30-day timeframe.
Secondary outcomes included overall mortality, mortality within 30 days, the requirement for surgery, and the length of hospital stay (LOS). The random-effects model was utilized to compute the combined odds ratios (OR) and mean differences (MD), along with their corresponding confidence intervals (CI) for variables, whether they were proportional or continuous, as suitable.
Overall, 11 studies, of which nine were randomized controlled trials (RCTs), included a total of 833 volunteers. Among these patients, 431 underwent endoscopic therapy, while 402 received conservative therapy. Endoscopic therapy was linked with reduced instances of overall rebleeding (OR 0.41), rebleeding within 30 days (OR 0.43), overall mortality (OR 0.47), 30-day mortality (OR 0.43), a lower need for surgery (OR 0.44), and a shorter LOS (MD -3.17 days).
However, in a subgroup analysis that focused on RCTs, there was no substantial difference in overall mortality (OR 0.78) between the two treatment strategies. Within this subgroup, endoscopic therapy exhibited numerically lower rates of overall rebleeding (7.2% compared to 18.5% with conservative therapy), although this difference did not reach statistical significance (OR 0.42). Importantly, a reduced rate of the need for surgery (OR 0.28) was observed with endoscopic therapy in comparison with conservative therapy.
The meta-analysis findings highlighted that, in the context of managing bleeding ulcers with adherent clots, endoscopic therapy, as opposed to conservative therapy, generally led to lower occurrences of rebleeding (both overall and within 30 days), reduced mortality (both overall and within 30 days), a decreased need for surgery, and shorter LOS. However, it is important to highlight that in the subgroup analysis of RCTs, endoscopic therapy showed slightly lower rates of overall rebleeding, although this difference was not statistically significant.
However, it did show a statistically significant advantage in terms of the need for surgery when compared to conservative therapy, despite similar overall mortality rates. Moreover, a combined approach involving thermal therapy and injection therapy emerged as the most effective method for diminishing the risk of rebleeding. It's important to emphasize that further validation of these findings will be necessary through large-scale RCTs.
Digestive Diseases and Sciences
Endoscopic Versus Conservative Therapy for Bleeding Peptic Ulcer with Adherent Clot: A Comprehensive Systematic Review and Meta-Analysis
Azizullah Beran et al.
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