title: Meta-analysis: predictors of rebleeding after endoscopic treatment for bleeding peptic ulcer.
abstract: 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.
  
  
  OBJECTIVE
  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 abstraction 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.
authors: Digestive Diseases Department, Hospital de Sabadell, Institut Universitari Parc Taulí, Departament de Medicina, Universitat Autònoma de Barcelona, Spain.
authors: P
authors: P
authors: García-Iglesias
authors: A
authors: A
authors: Villoria
authors: D
authors: D
authors: Suarez
authors: E
authors: E
authors: Brullet
authors: M
authors: M
authors: Gallach
authors: F
authors: F
authors: Feu
authors: J P
authors: JP
authors: Gisbert
authors: A
authors: A
authors: Barkun
authors: X
authors: X
authors: Calvet
mesh_terms: D016099:Endoscopy, Gastrointestinal; D016558:Hemostasis, Endoscopic; D006801:Humans; D016017:Odds Ratio; D010438:Peptic Ulcer Hemorrhage / Q000175:diagnosis* / Q000601:surgery; D011379:Prognosis; D012008:Recurrence; D012307:Risk Factors