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Evidence summaries

Epinephrine Injection Versus Epinephrine Injection and a Second Endoscopic Method in High Risk Bleeding Ulcers

Additional endoscopic treatment after epinephrine injection reduces further bleeding and the need for surgery in patients with bleeding peptic ulcer. Level of evidence: "A"

A Cochrane review [Abstract] 1 included 19 studies with a total of 2 033 subjects. 11 studies used a second injected agent, five used a mechanical method (haemoclips) and three employed thermal methods.

The risk of further bleeding after initial haemostasis was lower in the combination therapy groups than in the epinephrine alone group, regardless of which second procedure was applied (RR 0.53, 95% CI 0.35 to 0.81). Adding any second procedure significantly reduced the overall bleeding rate (persistent and recurrent bleeding) (RR 0.57, 95% CI 0.43 to 0.76) and the need for emergency surgery (RR 0.68, 95% CI 0.50 to 0.93). Mortality rates were not significantly different when either method was applied.

References

  • Vergara M, Bennett C, Calvet X et al. Epinephrine injection versus epinephrine injection and a second endoscopic method in high-risk bleeding ulcers. Cochrane Database Syst Rev 2014;10():CD005584. [PubMed]

Primary/Secondary Keywords