دورية أكاديمية
Topical hemostatic agents in the management of upper gastrointestinal bleeding: a meta-analysis
| العنوان: | Topical hemostatic agents in the management of upper gastrointestinal bleeding: a meta-analysis |
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| المؤلفون: | Ali A. Alali, Sarvee Moosavi, Myriam Martel, Majid Almadi, Alan N. Barkun |
| المصدر: | Endoscopy International Open, Vol 11, Iss 04, Pp E368-E385 (2023) |
| بيانات النشر: | Georg Thieme Verlag KG, 2023. |
| سنة النشر: | 2023 |
| المجموعة: | LCC:Diseases of the digestive system. Gastroenterology |
| مصطلحات موضوعية: | Diseases of the digestive system. Gastroenterology, RC799-869 |
| الوصف: | Background and study aims Novel topical hemostatic agents have shown promising results in treating patients with non-variceal upper gastrointestinal bleeding (NVUGIB). However, data are limited even in published meta-analyses as to their role, especially compared to conventional endoscopic approaches. The aim of this study was to perform a highly comprehensive systematic review assessing the effectiveness of topical hemostatic agents in UGIB in different clinical settings. Methods We performed a literature search of OVID MEDLINE, EMBASE, and ISI Web of Knowledge databases through September 2021. Studies assessing the efficacy of topical hemostatic agents in UGIB were included. Main outcomes were immediate hemostasis and overall rebleeding. Results A total of 980 citations were identified and 59 studies with a total of 3,417 patients were included in the analysis. Immediate hemostasis was achieved in 93 % (91 %; 94 %), with similar results according to etiology (NVUGIB vs. variceal), topical agent used, or treatment strategy (primary vs. rescue). The overall rebleeding rate was 18 % (15%; 21 %) with the majority of rebleeds occurring in the first 7 days. Among comparative studies, topical agents achieved immediate hemostasis more often than standard endoscopic modalities (OR 3.94 [1.73; 8.96), with non-different overall rebleeding odds (OR 1.06 [0.65; 1.74]). Adverse events occurred in 2 % (1 %; 3 %). Study quality was overall low to very low. Conclusions Topical hemostatic agents are effective and safe in the management of UGIB with favorable outcomes when compared to conventional endoscopic modalities across a variety of bleeding etiologies. This is especially true in novel subgroup analyses that assessed immediate hemostasis and rebleeding among RCTs and in malignant bleeding. Due to methodological limitations of available data, additional studies are needed to ascertain their effectiveness more confidently in the management of patients with UGIB. |
| نوع الوثيقة: | article |
| وصف الملف: | electronic resource |
| اللغة: | English |
| تدمد: | 2364-3722 2196-9736 |
| Relation: | https://doaj.org/toc/2364-3722; https://doaj.org/toc/2196-9736 |
| DOI: | 10.1055/a-1984-6895 |
| URL الوصول: | https://doaj.org/article/3b81f9e19084437782477ba45db1a179 |
| رقم الأكسشن: | edsdoj.3b81f9e19084437782477ba45db1a179 |
| قاعدة البيانات: | Directory of Open Access Journals |
Full Text Finder | تدمد: | 23643722 21969736 |
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| DOI: | 10.1055/a-1984-6895 |