Treating bleeding peptic ulcer with adherent clots with endoscopic therapy resulted in  reduced rebleeding events, lesser need for surgery, and fewer deaths, Azizullah Beran, MD, said during his abstract presentation at the 2022 ACG Annual Scientific Meeting on October 24  in Charlotte, North Carolina.

Dr Beran specializes in gastrointestinal disorders in the Gastroenterology and Hepatology division at the Indiana University in Indianapolis, Indiana.

His oral presentation was named an ACG Newsworthy Abstract in the IBD category.

Dr Beran said even though peptic ulcer disease (PUD) is the leading cause of upper gastrointestinal bleeding, information on the therapies for managing PUD is insufficient.

For the systematic review and meta-analysis, Dr Beran and collegaues included all randomized controlled trials comparing the endoscopic and conservative therapeutic approaches for bleeding PUDs with adherent clots through May 15, 2022, from the MEDLINE, EMBASE, and the Web of Science databases. They evaluated 839 patients (434 endoscopic therapy and 405 conservative therapy) on 3 outcomes: rebleeding, need for surgery, and mortality.

The endoscopic treatment group yielded superior results over the conservative therapy group on all outcomes. Rebleeding occurred in 8.1% of patients in the endoscopic therapy group, compared to 20.7% in the conservative therapy group. The need for surgery in the endoscopic therapy group was 4.3% compared to the 9.9% in the conservative therapy group. Mortality in the endoscopic therapy group was much lower (3.7%) than in the conservative therapy group (8%).

“Our meta-analysis demonstrated that endoscopic therapy is superior to conservative treatment for bleeding PUDs with an adherent clot regarding rebleeding, need for surgery, and moratlity,” Dr Beran said. “However, large scale random controlled trials are need to validate the findings.”

—Priyam Vora

Reference:
Beran A. Endoscopic vs Conservative Treatment for Bleeding Peptic Ulcer With Adherent Clot: A Comprehensive Systematic Review and Meta-Analysis of Randomized Controlled Trials. Oral paper presentation. Presidential Plenary session 2. Presented at: ACG 2022 Annual scientific meeting and Postgraduate course. Charlotte, North Carolina. October 24,