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Doppler probe exam less costly, more effective for upper GI bleeding assessment
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Doppler probe exam was a dominant strategy for assessment of upper gastrointestinal bleeding in terms of both efficacy and cost, according to study results published in Clinical Gastroenterology and Hepatology.
“Critical to modern management of non-variceal upper gastrointestinal bleeding [NVUGIB] is stratifying patients into those exhibiting lesions at low and high-risk of rebleeding as the latter undergo timely endoscopic hemostasis,” Alan Barkun, MD, of the division of gastroenterology at McGill University Health Centre in Montreal, Canada, and colleagues wrote. “The determination of the risk of a bleeding lesion has historically been determined based on its endoscopic evaluation, yet results assessing use of a non-EUS through-the-scope Doppler ultrasound probe for this purpose have been reported and suggest improvements in outcomes.”
Researchers designed a decision tree to represent the choice between DPE and traditional endoscopic visual assessment to assess the cost-effectiveness of using a Doppler probe exam (DPE) for the management of patients with NVUGIB. They used clinical probabilities from randomized controlled trials to determine if DPE provided any additional advantage in cost and effectiveness.
Investigators determined that more patients who underwent DPE were able to avoid rebleeding (92.6%) compared with patients who underwent endoscopic assessment (78.6%). The procedure was also less expensive than endoscopic assessment ($8,502 vs. $9,104).
Barkun and colleagues wrote that DPE’s dominance remained steady whether it was used in assessing bleeding lesions and the completeness of endoscopic hemostasis or only the latter.
“The dominant economic strategy of DPE can be broadly applied, not only in situations where DPE is only used following endoscopic hemostasis, but also in situations when DPE is used before and then again immediately after endoscopic hemostasis to assess for subsurface arterial blood,” they wrote. – by Alex Young
Disclosures: Barkun reports serving as consultant for Cook Inc., Pendopharm Inc., and Olympus. He also received research support from and served on the advisory committee for Olympus. Barkun also received funds from Pendopharm Inc. Please see the full study for all other authors’ relevant financial disclosures.
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