Endoscopic hemostasis. An effective therapy for bleeding peptic ulcers

• Published in: JAMA : the journal of the American Medical Association Vol. 264; no. 4; p. 494
• Main Authors: Sacks, H S, Chalmers, T C, Blum, A L, Berrier, J, Pagano, D
• Format: Journal Article
• Language: English
• Published: United States 25.07.1990
• Subjects: Adult; Aged; Duodenal Ulcer - complications; Duodenoscopy; Electrocoagulation; Emergencies; Female; Gastroscopy; Hemostatic Techniques; Humans; Light Coagulation; Male; Meta-Analysis as Topic; Middle Aged; Peptic Ulcer Hemorrhage - mortality; Peptic Ulcer Hemorrhage - surgery; Peptic Ulcer Hemorrhage - therapy; Randomized Controlled Trials as Topic; Recurrence; Sclerotherapy; Stomach Ulcer - complications
• ISSN: 0098-7484
• DOI: 10.1001/jama.1990.03450040090037

We performed a meta-analysis of 25 randomized control trials that compared endoscopic hemostasis with standard therapy for bleeding peptic ulcer. For recurrent or continued bleeding, the mean rate in control patients was 0.39, and the pooled rate difference, or reduction due to therapy, was 0.27 +/- 0.15 (95% confidence interval) (69% relative reduction). For emergency surgery, the mean rate in control patients was 0.26, and the pooled rate difference was 0.16 +/- 0.05 (62% relative reduction). Most important, for overall mortality, the mean rate in control patients was 0.10, and the pooled rate difference was 0.03 +/- 0.02 (30% relative reduction). The effects were greatest in patients with spurting or visible blood vessels and equivocal when the ulcer showed only signs of recent bleeding. We conclude that endoscopic hemostasis is clearly effective but that data were insufficient for direct comparisons between modalities. Randomized control trials to compare the different modes of endoscopic therapy should continue.