Systematic review and meta-analysis of endoscopic versus medical management of peptic ulcers with adherent clots

Area of Science:

• Gastroenterology
• Endoscopy
• Internal Medicine

Background:

• Peptic ulcer disease is a common cause of upper gastrointestinal bleeding.
• Optimal management for peptic ulcers with adherent clots remains uncertain.
• Current guidelines address active bleeding but not adherent clots.

Purpose of the Study:

• To systematically review the efficacy of endoscopic versus medical management for peptic ulcers with adherent clots.
• To evaluate the impact on recurrent bleeding, mortality, and need for surgery.

Main Methods:

• Systematic literature search of MEDLINE, Embase, and CENTRAL up to September 2022.
• Included randomized controlled trials comparing endoscopic and medical management for ulcers with adherent clots.
• Performed a random-effects meta-analysis to assess recurrent bleeding risk.

Main Results:

• Seven randomized controlled trials with 268 participants were included.
• Endoscopic hemostatic treatment significantly reduced recurrent bleeding (RR=0.40, 95% CI 0.16-0.95).
• No significant differences were observed in mortality (RR=0.90) or ulcer surgery rates (RR=0.48).

Conclusions:

• Endoscopic hemostatic techniques are effective in reducing recurrent bleeding for peptic ulcers with adherent clots.
• Medical management alone is less effective for preventing re-bleeding in these cases.
• Endoscopic treatment does not increase mortality or the need for surgical intervention.