The Role of the Endoscopic Doppler Probe in Non-Variceal Upper Gastrointestinal Bleeding: a systematic review and meta-analysis

Institut des Maladies de l'Appareil Digestif, Service de Gastroentérologie, Oncologie Digestive et Assistance Nutritionnelle, Nantes, France. Nantes Université, CHU Nantes1, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, ITUN5, F-44000, Nantes, France. Research Institute of the McGill University Health Center, Montreal, Quebec, Canada. CHU Dijon-Bourgogne, INSERM, Université de Bourgogne, CIC 1432, module plurithématique, F-21000, Dijon, France. Department of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia. Division of Gastroenterology, McGill University Health Center, McGill University, Montreal, Canada.

Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society. 2022

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INTRODUCTION The effectiveness of the Doppler Endoscopic Probe (DEP) remains unclear in non-variceal upper gastrointestinal bleeding (NVUGIB). We thus performed a systematic review characterizing the effectiveness of DEP in patients with NVUGIB addressing this question. METHODS A literature search was done until July 2021 using MEDLINE, EMBASE, and ISI Web of Science. A series of meta-analyses were performed assessing outcomes amongst observational and interventional studies for DEP signal positive and negative lesions as well as DEP-assisted versus standard endoscopies. The primary outcome was "overall rebleeding"; secondary outcomes included all-cause mortality, bleeding-related mortality, need for surgery, length of stay, ICU stay and angiography. RESULTS Fourteen studies were included from 1911 citations identified: Observational studies compared bleeding lesions with DEP positive versus DEP negative signals (11 studies n=800 pre-hemostasis, and n=148 with post-hemostasis data from 5 studies). Three interventional studies (n=308) compared DEP-assisted to standard endoscopy management. DEP signal positive versus negative lesions both prior to or following any possible hemostasis were at greater risk of overall rebleeding (OR=6.54 (2.36; 18.11, and OR=25.96; (6.74; 100.0), respectively). The use of DEP during upper endoscopy significantly reduced overall rebleeding rates (OR=0.27 (0.14; 0.54). When removing outcomes analysis for which only one study was available, all evaluable outcomes were improved with DEP characterization of management guidance except for all-cause mortality. DISCUSSION Although low certainty evidence, DEP-related information improves on sole visual prediction of rebleeding in NVUGIB, with DEP-guided management yielding decreased overall rebleeding, bleeding-related mortality and need for surgery.
Study details
Study Design : Systematic Review
Language : eng
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine