Background And Objective: Optimal endoscopic hemostasis remains undetermined. This was a systematic review of contemporary methods of endoscopic hemostasis for patients with bleeding ulcers that exhibited high-risk stigmata.
Setting: Randomized trials that evaluated injection, thermocoagulation, clips, or combinations of these were evaluated from MEDLINE, EMBASE, and CENTRAL (1990-2006).
Patients: A total of 4261 patients were evaluated.
Outcomes: Outcomes were rebleeding (primary), surgery, and mortality (secondary). Summary statistics were determined; publication bias and heterogeneity were sought by using funnel plots or by subgroup analyses and meta-regression.
Results: Forty-one trials assessed 4261 patients. All endoscopic therapies decreased rebleeding versus pharmacotherapy alone, including sole intravenous (IV) proton pump inhibition (PPI) (OR 0.56 [95% CI, 0.34-0.92]); only one trial assessed high-dose IV PPI. Injection alone was inferior compared with other methods, except for thermal hemostasis (OR 1.02 [95% CI, 0.74-1.40]), with a strong trend of increased rebleeding if 1 injectate is used rather than 2 (OR 1.40 [95% CI, 0.95-2.05]). Injection followed by thermal therapy did not decrease rebleeding compared with clips (OR 0.82 [95% CI, 0.28-2.38]) or thermal therapy alone (OR 0.79 [95% CI, 0.24-2.62]). Subgroup analysis, however, suggested that injection followed by thermal therapy was superior to thermal therapy alone. Clips were superior to thermal therapy (OR 0.24 [95% CI, 0.06-0.95]) but, when followed by injection, were not superior to clips alone (OR 1.30 [95% CI, 0.36-4.76]). Surgery or mortality was not altered in most comparisons.
Conclusions: All endoscopic treatments are superior to pharmacotherapy alone; only 1 study assessed high-dose IV PPI. Optimal endoscopic therapies include thermal therapy or clips, either alone or in combination with other methods. Additional data are needed that compare injection followed by thermal therapy to clips alone or clips combined with another method.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1016/j.gie.2008.05.031 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Water vapor thermal therapy for treatment of lower urinary tract symptoms due to large benign prostatic hyperplasia (≥ 80 g).
World J Urol
January 2025
Department of Urology, AP-HM, North Hospital, Marseille, France.
Introduction: Water vapor thermal therapy (WVTT; REZUM™; Boston, USA) offers symptom relief with reduced risks of complications in patients with lower urinary tract symptoms (LUTS) related to benign prostatic obstruction (BPO). WVTT therapy has been validated in the pivotal study in men with smaller prostates (< 80 cc). Yet, its feasibility for larger prostates (≥ 80 cc) remains underexplored.
View Article and Find Full Text PDFChessboard-like Burn Wound Healing Model of Mice Based on Digital Heating Device.
J Vis Exp
December 2024
State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University; Department of Endodontics, West China Hospital of Stomatology, Sichuan University;
Severe burn injuries are among the most traumatic and physically debilitating conditions, impacting nearly every organ system and resulting in considerable morbidity and mortality. Given their complexity and the involvement of multiple organs, various animal models have been created to replicate different facets of burn injury. Methods used to produce burned surfaces vary among experimental animal models.
View Article and Find Full Text PDFScutellarein Inhibits Osteosarcoma Growth by Targeting the TLR4/TRAF6/NF-κB Pathway.
Drug Des Devel Ther
January 2025
Department of Trauma Orthopedics, Affiliated Hospital of Jining Medical University, Jining, Shandong, 272007, People's Republic of China.
Purpose: Osteosarcoma (OS) is the most common malignant tumor associated with poor patient outcomes and a limited availability of therapeutic agents. Scutellarein (SCU) is a monomeric flavone bioactive compound with potent anti-cancer activity. However, the effects and mechanisms of SCU on the growth of OS remain unknown.
View Article and Find Full Text PDFData characterizing a panel of biodegradable cross-linked polyester implants for sustained delivery of an anti-viral drug.
Data Brief
February 2025
Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto M5S 3M2, Canada.
Tenofovir alafenamide (TAF) is currently administered orally to patients for treatment of chronic hepatitis B virus infection and as a part of a combination therapy for human immunodeficiency virus (HIV) infection. A long-acting delivery system could provide several advantages as a formulation strategy for this drug including improved patient adherence, convenience, more consistent drug levels and potentially fewer side effects. To date, the vast majority of polymer-based long-acting delivery systems have been prepared from poly(lactide--glycolide) [1].
View Article and Find Full Text PDFTreatment efficacy prediction of focused ultrasound therapies using multi-parametric magnetic resonance imaging.
Cancer Prev Detect Interv (2024)
October 2024
Magnetic resonance guided focused ultrasound (MRgFUS) is one of the most attractive emerging minimally invasive procedures for breast cancer, which induces localized hyperthermia, resulting in tumor cell death. Accurately assessing the post-ablation viability of all treated tumor tissue and surrounding margins immediately after MRgFUS thermal therapy residual tumor tissue is essential for evaluating treatment efficacy. While both thermal and vascular MRI-derived biomarkers are currently used to assess treatment efficacy, currently, no adequately accurate methods exist for the in vivo determination of tissue viability during treatment.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!