title: Endoscopic therapy versus medical therapy for bleeding peptic ulcer with adherent clot: a meta-analysis.
abstract: OBJECTIVE
  The optimal management of bleeding peptic ulcer with adherent clot is controversial and may include endoscopic therapy or medical therapy.
  
  
  METHODS
  We searched MEDLINE, BIOSIS, EMBASE, and the Cochrane Library to identify all randomized controlled trials comparing the 2 interventions. Outcomes evaluated in the meta-analysis were recurrent bleeding, need for surgical intervention, length of hospitalization, transfusion requirement, and mortality.
  
  
  RESULTS
  Six studies were identified that included 240 patients from the United States, Hong Kong, South Korea, and Spain. Patients in the endoscopic therapy group underwent endoscopic clot removal and treatment of the underlying lesion with thermal energy, electrocoagulation, and/or injection of sclerosants. Rebleeding occurred in 5 of 61 (8.2%) patients in the endoscopic therapy group, compared with 21 of 85 (24.7%) in the medical therapy group (P = .01), for a pooled relative risk of 0.35 (95% confidence interval, 0.14-0.83; number needed to treat, 6.3). There was no difference between endoscopic therapy and medical therapy in length of hospital stay (mean, 6.8 vs 5.6 days; P = .27), transfusion requirement (mean, 3.0 vs 2.8 units of packed red blood cells; P = .75), or mortality (9.8% vs 7%; P = .54). Patients in the endoscopic therapy group were less likely to undergo surgery (pooled relative risk, 0.43; 95% confidence interval, 0.19-0.98; number needed to treat, 13.3); however, this outcome became nonsignificant when only peer-reviewed studies were considered.
  
  
  CONCLUSIONS
  Endoscopic therapy is superior to medical therapy for preventing recurrent hemorrhage in patients with bleeding peptic ulcers and adherent clots. The interventions are comparable with respect to the need for surgical intervention, length of hospital stay, transfusion requirement, and mortality.
authors.affiliation: Indiana University Medical Center, and Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana 46202, USA. ckahi2@iupui.edu
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Kahi
authors.forename: Dennis M
authors.initials: DM
authors.lastname: Jensen
authors.forename: Joseph J Y
authors.initials: JJ
authors.lastname: Sung
authors.forename: Brian L
authors.initials: BL
authors.lastname: Bleau
authors.forename: Hye Kyung
authors.initials: HK
authors.lastname: Jung
authors.forename: George
authors.initials: G
authors.lastname: Eckert
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Imperiale
mesh_terms: D001803:Blood Transfusion; D004724:Endoscopy; D006801:Humans; D007902:Length of Stay; D010438:Peptic Ulcer Hemorrhage / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome