Meta‐analysis: predictors of rebleeding after endoscopic treatment for bleeding peptic ulcer

• Published in: Alimentary pharmacology & therapeutics 2011-10, Vol.34 (8), p.888-900
• Main Authors: García‐Iglesias, P., Villoria, A., Suarez, D., Brullet, E., Gallach, M., Feu, F., Gisbert, J. P., Barkun, A., Calvet, X.
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Digestive system; Endoscopy, Gastrointestinal; Gastroenterology. Liver. Pancreas. Abdomen; Hemostasis, Endoscopic; Humans; Medical sciences; Odds Ratio; Other diseases. Semiology; Peptic Ulcer Hemorrhage - diagnosis; Peptic Ulcer Hemorrhage - surgery; Pharmacology. Drug treatments; Prognosis; Recurrence; Risk Factors; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus
• ISSN: 0269-2813; 1365-2036
• DOI: 10.1111/j.1365-2036.2011.04830.x

Aliment Pharmacol Ther 2011; 34: 888–900 Summary Background  Determining the risk of rebleeding after endoscopic therapy for peptic ulcer bleeding (PUB) may be useful for establishing additional haemostatic measures in very high‐risk patients. Aim  To identify predictors of rebleeding after endoscopic therapy. Methods  Bibliographic database searches were performed to identify studies assessing rebleeding after endoscopic therapy for PUB. All searches and data ion were performed in duplicate. A parameter was considered to be an independent predictor of rebleeding when it was detected as prognostic by multivariate analyses in ≥2 studies. Pooled odds ratios (pOR) were calculated for prognostic variables. Results  Fourteen studies met the prespecified inclusion criteria. Pre‐endoscopic predictors of rebleeding were: (i) Haemodynamic instability: significant in 9 of 13 studies evaluating the variable (pOR: 3.30, 95% CI: 2.57–4.24); (ii) Haemoglobin value: significant in 2 of 10 (pOR: 1.73, 95% CI: 1.14–2.62) and (iii) Transfusion: significant in two of six (pOR not calculable). Endoscopic predictors of rebleeding were: (i) Active bleeding: significant in 6 of 12 studies (pOR: 1.70, 95% CI: 1.31–2.22); (ii) Large ulcer size: significant in 8 of 12 studies (pOR: 2.81, 95% CI: 1.98–4.00); (iii) Posterior duodenal ulcer location: significant in four of eight studies (pOR: 3.83, 95% CI: 1.38–10.66) and (iv) High lesser gastric curvature ulcer location: significant in three of eight studies (pOR: 2.86; 95% CI: 1.69–4.86). Conclusions  Major predictors for rebleeding in patients receiving endoscopic therapy are haemodynamic instability, active bleeding at endoscopy, large ulcer size, ulcer location, haemoglobin value and the need for transfusion. These risk factors may be useful for guiding clinical management in patients with PUB.