[Endoscopic hemostasis for hemorrhagic gastroduodenal ulcer. Meta-analysis of randomized clinical trials].

Abstract

To demonstrate the advantages of various endoscopic hemostatic methods (laser photocoagulation, electrocautery, injection therapy) for bleeding gastroduodenal ulcer in patients at high risk for continued or recurrent bleeding, a critical review of published randomized clinical trials was made with meta-analytic methods. Only the 15 clinical trials dealing either with patients with visible non bleeding vessels or spurting arterial bleeding were included. Regarding visible non bleeding vessels, the meta-analysis of five trials on electrocautery and two trials on sclerotherapy showed a significant reduction in rebleeding rates in the treatment group compared with untreated controls. The odds ratios were 4 (95 percent confidence levels (CL): 2.4-6.9) (P less than 0.001) and 6.8 (95 percent CL: 2.7-17.2) (P less than 0.001), respectively. As well, the meta-analysis of four trials on electrocautery and the two trials on sclerotherapy showed a significant reduction in the number of emergency surgical operations in the treated groups a compared with the untreated groups. The odds ratios were 5.5 (95 percent confidence levels (CL): 2.7-11.3) (P less than 0.001) and 6.1 (95 percent CL: 2.1-17.8) (P less than 0.001), respectively. Meta-analysis did not show any advantage for laser, electrocautery, or sclerotherapy in terms of mortality. Indirect meta-analysis did not reveal any difference between electrocautery and sclerotherapy. Regarding spurting arterial bleeding, meta-analysis of the two YAG laser trials, the two Argon laser trials, and the two electrocautery trials showed a significant reduction of rebleeding or continued bleeding in the treatment groups as compared with the control groups.(ABSTRACT TRUNCATED AT 250 WORDS)

• Authors: S Naveau, C Perrier, B Mory, T Poynard, J C Chaput
• Journal: Gastroenterologie clinique et biologique (Gastroenterol Clin Biol) Vol. 15 Issue 8-9 Pg. 580-7 ( 1991) ISSN: 0399-8320 [Print] France
• Vernacular Title: Hémostase endoscopique des hémorragies ulcéreuses gastro-duodénales. Méta-analyse des essais randomisés.
• PMID: 1836438 (Publication Type: Clinical Trial, English Abstract, Journal Article, Meta-Analysis, Randomized Controlled Trial)

Chemical References

• Sclerosing Solutions

Topics

• Duodenal Ulcer (complications)
• Electrocoagulation (methods)
• Endoscopy, Gastrointestinal (methods)
• Humans
• Laser Therapy (methods)
• Meta-Analysis as Topic
• Peptic Ulcer Hemorrhage (etiology, mortality, therapy)
• Randomized Controlled Trials as Topic
• Recurrence
• Reference Values
• Sclerosing Solutions (therapeutic use)
• Stomach Ulcer (complications)