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Meta-analysis: predictors of rebleeding after endoscopic treatment for bleeding peptic ulcer
Alimentary Pharmacology and Therapeutics, 09/09/2011
Evidence Based Medicine
Garcia–Iglesias P et al. – Major predictors for rebleeding in patients receiving endoscopic therapy are haemodynamic instability, active bleeding at endoscopy, large ulcer size, ulcer location, haemoglobin value and the need for transfusion. These risk factors may be useful for guiding clinical management in patients with peptic ulcer bleeding(PUB).
Methods- Bibliographic database searches were performed to identify studies assessing rebleeding after endoscopic therapy for PUB.
- All searches and data ion were performed in duplicate.
- Parameter was considered to be an independent predictor of rebleeding when it was detected as prognostic by multivariate analyses in ≥2 studies.
- Pooled odds ratios (pOR) were calculated for prognostic variables.
- 14 studies met the prespecified inclusion criteria.
- Pre–endoscopic predictors of rebleeding were: (i) Haemodynamic instability: significant in 9 of 13 studies evaluating the variable (pOR: 3.30, 95% CI: 2.57–4.24); (ii) Haemoglobin value: significant in 2 of 10 (pOR: 1.73, 95% CI: 1.14–2.62) and (iii) Transfusion: significant in two of six (pOR not calculable).
- Endoscopic predictors of rebleeding were: (i) Active bleeding: significant in 6 of 12 studies (pOR: 1.70, 95% CI: 1.31–2.22); (ii) Large ulcer size: significant in 8 of 12 studies (pOR: 2.81, 95% CI: 1.98–4.00); (iii) Posterior duodenal ulcer location: significant in four of eight studies (pOR: 3.83, 95% CI: 1.38–10.66) and (iv) High lesser gastric curvature ulcer location: significant in three of eight studies (pOR: 2.86; 95% CI: 1.69–4.86).