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Endoscopic clipping versus injection and thermo-coagulation in the treatment of bleeding non-variceal upper gastrointestinal bleeding: a meta-analysis
  1. Joseph JY Sung (joesung{at}cuhk.edu.hk)
  1. Chinese University of Hong Kong, Hong Kong
    1. Kelvin KF Tsoi (kelvintsoi{at}cuhk.edu.hk)
    1. Chinese University of Hong Kong, Hong Kong
      1. Larry H Lai (laihinlarry{at}yahoo.com)
      1. Chinese University of Hong Kong, Hong Kong
        1. Justin CY Wu (justinwu{at}cuhk.edu.hk)
        1. Chinese University of Hong Kong, Hong Kong
          1. James YW Lau (laujyw{at}surgery.cuhk.edu.hk)
          1. Chinese University of Hong Kong, Hong Kong

            Abstract

            Hemoclips, injection therapy and thermocoagulation (heater probe or electrocoagulation) are the most commonly used endoscopic hemostasis for the control of non-variceal gastrointestinal bleeding.

            Aim. To compare the efficacy of hemoclips versus injection or thermocoagulation in endoscopic hemostasis by pooling data from the literature

            Method. We search full publications in English literature (MEDLINE, EMBASE and Cochrane Library) as well as abstracts in major international conferences using the keywords 'hemoclips' and 'bleeding' and found 15 trials fulfilling the search criteria. Outcome measurements include 1. initial hemostasis (after endoscopic intervention), 2. recurrent bleeding, 3. definitive hemostasis (no recurrent bleeding until the end of follow up), 4. requirement for surgical intervention and 5. all cause mortality. We examined heterogeneity of trials and pooled the effects by meta-analysis.

            Results. Among 1,156 patients recruited in these 15 studies, 390 were randomized to receive clips alone, 242 received clip combined with injection, 359 received injection alone and 165 received thermocoagulation with or without injection. Definitive hemostasis is higher with hemoclips (86.5%) than injection (75.4%) (RR: 1.14, 95% CI: 1.00 - V 1.30); or endoscopic clips with injection (88.5%) compared with injections alone (78.1%) (RR: 1.13, 95% CI: 1.03 - V 1.23) leading to reduced requirement for surgery but no difference in mortality. Compared to thermocoagulation and clips has no improved definitive hemostasis (81.5% vs 81.2%) (RR: 1.00, 95% CI: 0.77 - V 1.31). These estimates were robust in sensitivity analyses. There was no difference in rebleeding, need for surgery and mortality. Reported locations of failed hemoclip applications included posterior wall of duodenal bulb, posterior wall of gastric body and lesser curve of stomach.

            Conclusion. Successful application of hemoclips is superior to injection alone but comparable to thermocoaulgation in producing definitive hemostasis. There was no difference in all cause mortality irrespective of the modalities of endoscopic treatment.

            • UGIB
            • clipping
            • endoscopic hemostasis
            • injection
            • thermocoagulation

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