Epinephrine injection versus epinephrine injection and a second endoscopic method in high risk bleeding ulcers

Area of Science:

• Gastroenterology
• Endoscopic interventions
• Hemorrhage control

Background:

• Endoscopic therapy is crucial for managing bleeding peptic ulcers, reducing rebleeding, surgery, and mortality.
• Epinephrine injection is a widely used endoscopic hemostatic method.
• Current guidelines lack consensus on the necessity of a second hemostatic procedure post-epinephrine injection.

Purpose of the Study:

• To evaluate if a second endoscopic hemostatic procedure, in addition to epinephrine injection, enhances efficacy and patient outcomes for high-risk bleeding peptic ulcers.

Main Methods:

• Systematic review and meta-analysis of randomized controlled trials.
• Searched multiple databases (CENTRAL, MEDLINE, EMBASE) and contacted experts.
• Included studies compared epinephrine alone versus epinephrine plus a second hemostatic method for bleeding peptic ulcers with major stigmata.

Main Results:

• Seventeen studies involving 1763 patients were analyzed.
• The addition of a second procedure significantly reduced further bleeding (18.8% to 10.4%), emergency surgery (10.8% to 7.1%), and mortality (5% to 2.5%).
• Further bleeding risk decreased irrespective of the second procedure used and across all subgroups.

Conclusions:

• Combined endoscopic treatment, including epinephrine injection followed by a second hemostatic procedure, is more effective than epinephrine alone.
• This strategy significantly lowers rebleeding rates, the need for urgent surgery, and overall mortality in patients with bleeding peptic ulcers.