Portal de Periódicos da CAPES

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

2007; Cochrane; Linguagem: Inglês

10.1002/14651858.cd005584.pub2

1469-493X

Mercedes Vergara, Xavier Calvet, Javier P. Gisbert,

Gastrointestinal Tumor Research and Treatment

Background Endoscopic therapy reduces re‐bleeding rate, and need for surgery, in patients with bleeding peptic ulcers. Injection of epinephrine is the most popular therapeutic method. Guidelines disagree on the need for a second haemostatic procedure immediately after epinephrine. Objectives The objective of this review was to determine whether the addition of a second procedure improves efficacy or patient outcomes or both after epinephrine injection in adults with high risk bleeding ulcers. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) which includes the Cochrane Upper Gastrointestinal and Pancreatic Diseases Group Trials Register (The Cochrane Library Issue 1, 2009); MEDLINE (1966 to September 2009; EMBASE (1980 to September 2009) and reference lists of articles. We also contacted experts in the field. Selection criteria Randomised studies comparing endoscopic treatment: epinephrine alone versus epinephrine associated with a second haemostatic method in adults with haemorrhage from peptic ulcer disease with major stigmata of bleeding as defined by the Forrest classification. Bleeding must have been confirmed by endoscopy. Data collection and analysis Two authors independently assessed trial quality and extracted data. Main results Eighteen studies including 1868 people were included. Adding a second procedure reduced further bleeding rate from 18.5% to 10%; Relative Risk 0.55; 95% confidence interval (CI) 0.42 to 0.73, and emergency surgery from 10.8% to 6.7%; RR 0.69; 95% CI 0.51 to 0.95. Mortality fell from 4.7% to 2.5% RR 0.52; 95% CI 0.38 to 1.05, without statistical significance. Subanalysis showed that the risk of further bleeding decreased regardless of which second procedure was applied. In addition, the risk was reduced in all subgroups. Authors' conclusions Additional endoscopic treatment after epinephrine injection reduces further bleeding and the need for surgery in patients with high bleeding peptic ulcer.