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

Area of Science:

• Gastroenterology
• Endoscopic interventions
• Peptic ulcer disease management

Background:

• Endoscopic therapy is a cornerstone in managing bleeding peptic ulcers, aiming to reduce rebleeding and surgical intervention.
• High-risk bleeding peptic ulcers present a significant clinical challenge, necessitating effective hemostatic strategies.

Purpose of the Study:

• To evaluate the efficacy of a second endoscopic procedure following epinephrine injection in adults with high-risk bleeding peptic ulcers.
• To determine if combined therapy improves hemostatic outcomes and patient recovery compared to epinephrine alone.

Main Methods:

• Systematic review and meta-analysis of randomized controlled trials (RCTs) comparing epinephrine alone versus epinephrine plus a second endoscopic method.
• Included studies focused on patients with major stigmata of bleeding (Forrest Ia-Ib-IIa-IIb) from peptic ulcers.
• Data were analyzed using a random-effects model, presenting risk ratios (RRs) with 95% confidence intervals (CIs).

Main Results:

• Nineteen RCTs involving 2033 participants were analyzed.
• Combined therapy significantly reduced the risk of further bleeding (RR 0.53) and the need for emergency surgery (RR 0.68) compared to epinephrine alone.
• The addition of a second therapy was particularly effective for Forrest Ia/Ib ulcers (oozing/spurting), reducing rebleeding rates (RR 0.66).

Conclusions:

• Additional endoscopic treatment after epinephrine injection effectively reduces rebleeding and surgery rates in high-risk bleeding peptic ulcers.
• Combined therapy demonstrates superior outcomes compared to epinephrine monotherapy, although specific treatment modalities were not definitively ranked.
• Adverse events, such as perforation and gastric wall necrosis, were infrequent and comparable between treatment groups.