Endoscopic therapy bests conservative therapy for bleeding peptic ulcer disease with clots
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CHARLOTTE, N.C. — Endoscopic therapy yielded lower rates of rebleeding, mortality and surgery compared with conservative therapy in patients with bleeding peptic ulcer diseases, according to a presenter at ACG Annual Scientific Meeting.
“Peptic ulcer disease (PUD) is the leading cause of upper GI bleeding,” Azizullah Beran, MD, a GI fellow at Indiana University School of Medicine and resident at the University of Toledo, said. “PUDs with an adherent clot are associated with a high risk of rebleeding and surgery. However, the optimal management of bleeding PUD with adherent clots including endoscopic vs. conservative therapy remains unclear.”
He added, “The most recent ACG guidelines in 2021 could not reach an agreement to advocate for or against endoscopic treatment for bleeding PUDs with adherent clots.”
In a systematic review and meta-analysis, Beran and colleagues evaluated 11 randomized controlled trials with 839 patients to determine the optimal therapeutic approach to manage bleeding peptic ulcer diseases with adherent clot. Patients in the endoscopic therapy group (n = 434) underwent clot removal and treatment of the underlying lesion with thermocoagulation, electrocoagulation, injection of sclerosants or hemoclipping. Remaining patients (n = 405) underwent conservative therapy.
According to study results, rebleeding occurred among 8.1% of patients in the endoscopic therapy group compared with 20.7% of patients in the conservative therapy group (RR = 0.45; 95% CI, 0.26-0.78). Further, patients in the endoscopic therapy group had lower rates of mortality (3.7% vs. 8%; RR = 0.49; 95% CI, 0.25-0.96) and subsequent need for surgery (4.3% vs. 9.9%; RR = 0.48; 95% CI, 0.24-0.97).
“Our meta-analysis demonstrated that endoscopic therapy was associated with lower rebleeding, mortality and need for surgery compared to conservative therapy. However, when subgroup analysis is restricted to randomized controlled trials, there was no significant difference in rebleeding, mortality and need for surgery between endoscopic therapy and conservative therapy groups,” Beran concluded. “Therefore, large-scale randomized controlled trials are needed to answer this clinically significant question.”
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Beran A, et al. Abstract S646: Endoscopic vs. conservative treatment for bleeding peptic ulcer with adherent clot: A comprehensive systematic review and meta-analysis of randomized controlled trials. Presented at: ACG Annual Scientific Meeting; Oct. 21-26, 2022; Charlotte, N.C. (hybrid meeting).
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