Evidence map›Paper›PMID 17443601›Full record

SynthesisThe Cochrane database of systematic reviews2007

Epinephrine injection versus epinephrine injection and a second endoscopic method in high risk bleeding ulcers.

M Vergara, X Calvet, J P Gisbert

Abstract readMeta-AnalysisSystematic Review
PubMed Publisher
In one paragraph

Synthesis in The Cochrane database of systematic reviews, 2007. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
25citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

25 citing papers in PubMed, 1 synthesis or guideline pooled it, 93 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Review
  4. Endoscopic management of post-bariatric surgery complications.World journal of gastrointestinal endoscopy · 2016
    Review
  5. Review
  6. Endoscopic hemostasis state of the art - Nonvariceal bleeding.World journal of gastrointestinal endoscopy · 2016
    Review
  7. Review
  8. Endoscopic treatment for high-risk bleeding peptic ulcers: A randomized, controlled trial of epinephrine alone with epinephrine plus fresh frozen plasma.Journal of research in medical sciences : the official journal of Isfahan University of Medical Sciences · 2016
    Article
  9. Diagnosis and therapy of non-variceal upper gastrointestinal bleeding.World journal of gastrointestinal pharmacology and therapeutics · 2015
    Review
  10. Review
  11. Review
  12. Review
  13. Article
  14. Review
  15. Endoscopic therapy for severe ulcer bleeding.Gastrointestinal endoscopy clinics of North America · 2011
    Review
  16. Therapeutic and interventional endoscopy for gastrointestinal bleeding.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2011
    Article
  17. Review
  18. Author's reply.Annals of gastroenterology · 2011
    Article
  19. Article
  20. Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

3 authors at 1 institution in 1 country.

M VergaraHospital de Sabadell, Unitat de Malaties Digestives, Institut Universitari Parc Tauli, Universitat Autonoma de Barcelona. Parc Tauli s/n, Sabadell, Spain, 08208. mvergara@cspt.es
X Calvet
J P Gisbert
Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas · ES

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundEndoscopic therapy reduces rebleeding rate, need for surgery, and mortality in patients with bleeding peptic ulcers. Injection of epinephrine is the most popular therapeutic method. Guidelines disagree on the need for a second haemostatic procedure immediately after epinephrine.

objectivesThe objective of this review was to determine whether the addition of a second procedure improves efficacy or patient outcomes or both after epinephrine injection in adults with high risk bleeding ulcers. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials - CENTRAL (which includes the Cochrane Upper Gastrointestinal and Pancreatic Diseases Group Trials Register) (The Cochrane Library Issue 1, 2006), MEDLINE (1966 to February 2006), EMBASE (1980 to February 2006) and reference lists of articles. We also contacted experts in the field. SELECTION CRITERIA: Randomised studies comparing endoscopic treatment: epinephrine alone versus epinephrine associated with a second haemostatic method in adults with haemorrhage from peptic ulcer disease with major stigmata of bleeding as defined by the Forrest classification. Bleeding must have been confirmed by endoscopy. DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial quality and extracted data. MAIN

resultsSeventeen studies including 1763 people were included. Adding a second procedure reduced further bleeding rate from 18.8% to 10.4%; Peto Odds Ratio 0.51; 95% confidence interval (CI) 0.39 to 0.66, and emergency surgery from 10.8% to 7.1%; OR 0.63; 95% CI 0.45 to 0.89. Mortality fell from 5% to 2.5% OR 0.50; 95% CI 0.30 to 0.82. Subanalysis showed that the risk of further bleeding decreased regardless of which second procedure was applied. In addition, the risk was reduced in all subgroups. AUTHORS'

conclusionsAdditional endoscopic treatment after epinephrine injection reduces further bleeding, the need for surgery and mortality in patients with bleeding peptic ulcer.

Indexed as

Combined Modality TherapyEpinephrineHemostasis, EndoscopicHumansPeptic Ulcer HemorrhageRandomized Controlled Trials as TopicSecondary PreventionVasoconstrictor AgentsEpinephrineVasoconstrictor Agents

Identifiers

PMID17443601
OpenAlexW4253672886

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.